title: Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?
abstract: OBJECTIVE
  To evaluate the impact of intravenous midazolam dose on the duration of recovery room stay for patients undergoing outpatient third molar surgery.
  
  
  METHODS
  Using a retrospective cohort study design, a sample of patients undergoing outpatient third molar surgery under intravenous sedation at Mayo Clinic from 2010 to 2014 was identified. All patients underwent extraction of all 4 third molars during a single operative procedure and the age range was limited to 14 to 29 years. The primary predictor variable was the total dose of intravenous midazolam administered during sedation. The primary outcome variable was recovery room length of stay (LOS) after completion of surgery. Multiple covariates also abstracted included patient age, gender, American Society of Anesthesiologists (ASA) score, duration of surgical procedure, complexity of surgical procedure, types and dosages of all intravenous medications administered during sedation, and volume of crystalloid fluid administered perioperatively. Univariable and multivariable models were developed to evaluate associations between the primary predictor variable and covariates relative to the primary outcome variable.
  
  
  RESULTS
  The study sample was composed of 2,610 patients. Mean age was 18.3 years (SD, 3.0 yr; range, 14 to 29 yr) and gender distribution was 52% female. Mean dosage of midazolam administered was 4.1 mg (SD, 1.1 mg; range, 0.5 to 10.0 mg). Variables predicting shorter LOS at multivariable analysis included older age (P < .001), male gender (P = .004), and administration of larger crystalloid fluid volumes (P < .001). Variables predicting longer LOS included higher ASA score (P < .001), administration of ketamine (P < .001), and administration of ketorolac (P < .001). The dose of midazolam administered during sedation was not found to be significantly associated with prolonged recovery room LOS in univariable or multivariable settings.
  
  
  CONCLUSIONS
  Dosage of intravenous midazolam does not appear to significantly impact the duration of recovery room stay in the prototypical patients undergoing sedation for outpatient third molar surgery.
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN. Electronic address: ettinger.kyle@mayo.edu.
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Ettinger
authors.affiliation: Associate Professor and Consultant, Department of Anesthesiology, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Adam K
authors.initials: AK
authors.lastname: Jacob
authors.affiliation: Assistant Professor and Program Chair, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Viozzi
authors.affiliation: Assistant Professor and Consultant, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: James M
authors.initials: JM
authors.lastname: Van Ess
authors.affiliation: Assistant Professor and Consultant, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: W Jonathan
authors.initials: WJ
authors.lastname: Fillmore
authors.affiliation: Assistant Professor and Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Kevin
authors.initials: K
authors.lastname: Arce
mesh_terms: D000293:Adolescent; D000328:Adult; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000009:adverse effects* / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D008964:Molar, Third / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam