title: Midazolam is associated with delay in recovery and agitation after ambulatory general anesthesia for dental treatment in patients with disabilities: a retrospective cohort study.
abstract: OBJECTIVE
  Some patients with intellectual disabilities (IDs) who undergo total intravenous anesthesia (TIVA) have complications associated with the anesthesia such as prolonged recovery. The purposes of this study were to estimate the frequency of TIVA complications among patients with IDs and to identify factors associated with TIVA complications.
  
  
  METHODS
  This study was designed as a retrospective cohort study. Study samples were selected from the clinical records of patients with IDs who underwent ambulatory general anesthesia in a special dental clinic at the Okayama University Hospital, Okayama, Japan. Predictor variables were patient background, anesthesia-related variables, and dental treatment. Outcome variables were delayed recovery and the complication of agitation. Factors affecting delayed recovery and complications were examined with multivariable analysis.
  
  
  RESULTS
  We enrolled 106 cases (81 male and 25 female patients) in this study. The mean age was 23.9 years. Serious complications were not observed in any cases. The amount of intravenous midazolam was an independent determinant of delayed recovery. Oral midazolam contributed to delayed recovery, although it is very useful for induction in patients with a high level of fear. Oral midazolam and a younger age were independent predictors of agitation.
  
  
  CONCLUSIONS
  Intravenous midazolam may not have an advantage in ambulatory general anesthesia. Oral midazolam contributes to delayed recovery and is an independent predictor of agitation.
authors.affiliation: Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan. maedas@md.okayama-u.ac.jp
authors.forename: Shigeru
authors.initials: S
authors.lastname: Maeda
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Tomoyasu
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Higuchi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mori
authors.forename: Masahiko
authors.initials: M
authors.lastname: Egusa
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyawaki
mesh_terms: D000284:Administration, Oral; D000328:Adult; D017109:Akathisia, Drug-Induced / Q000209:etiology*; D000553:Ambulatory Care; D000704:Analysis of Variance; D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D015331:Cohort Studies; D055191:Delayed Emergence from Anesthesia / Q000139:chemically induced*; D003730:Dental Care for Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D019989:Persons with Intellectual Disabilities; D012044:Regression Analysis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam