The safety and efficacy of intranasal midazolam sedation combined with inhalation sedation with nitrous oxide and oxygen in paediatric dental patients as an alternative to general anaesthesia.
BACKGROUND
Conscious Decision' was published in 2000 by the Department of Health, effectively ending the provision of dental general anaesthesia (DGA) outside the hospital environment. Other aspects of dental anxiety and behavioural management and sedation techniques were encouraged before the decision to refer for a DGA was reached. Although some anxious children may be managed with relative analgesia (RA), some may require different sedation techniques for dentists to accomplish dental treatment. Little evidence has been published in the UK to support the use of alternative sedation techniques in children. This paper presents another option using an alternative conscious sedation technique.


OBJECTIVE
to determine whether a combination of intranasal midazolam (IN) and inhalation sedation with nitrous oxide and oxygen is a safe and practical alternative to DGA.


METHODS
A prospective clinical audit of 100 cases was carried out on children referred to a centre for DGA.


METHODS
100 children between 3 and 13 years of age who were referred for DGA were treated using this technique. Sedation was performed by intranasal midazolam followed by titrating a mixture of nitrous oxide and oxygen. A range of dental procedures was carried out while the children were sedated. Parents were present during the dental treatment. Data related to the patient, dentistry and treatment as well as sedation variables were collected at the treatment visit and a telephonic post-operative assessment from the parents was completed a week later.


RESULTS
It was found that 96% of the required dental treatment was completed successfully using this technique, with parents finding this technique acceptable in 93% of cases. 50% of children found the intranasal administration of the midazolam acceptable. There was no clinically relevant oxygen desaturation during the procedure. Patients were haemodynamically stable and verbal contact was maintained throughout the procedure.


CONCLUSIONS
In selected cases this technique provides a safe and effective alternative to DGA and could reduce the number of patients referred to hospitals for DGA. It is recommended that this technique should only be used by dentists skilled in sedation with the appropriate staff and equipment at their disposal.
Wood
Michael
M
Specialist in Special Care Dentistry, Leagrave Dental Anaesthetic Clinic, Luton, Bedfordshire.
D000281:Administration, Intranasal; D000293:Adolescent; D000766:Anesthesia, Dental; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001294:Attitude to Health; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D003299:Cooperative Behavior; D003448:Crying; D016854:Dental Anxiety / Q000628:therapy; D019230:Dental Audit; D019140:Dental Care for Children; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008568:Memory; D008874:Midazolam / Q000008:administration & dosage*; D009068:Movement; D009609:Nitrous Oxide / Q000008:administration & dosage*; D010100:Oxygen / Q000008:administration & dosage*; D011446:Prospective Studies; D012449:Safety; D013997:Time Factors
D018685:Anesthetics, Inhalation; D006993:Hypnotics and Sedatives; D009609:Nitrous Oxide; D008874:Midazolam; D010100:Oxygen