title: Premedication with midazolam in intellectually disabled dental patients: intramuscular or oral administration? A retrospective study.
abstract: BACKGROUND
  The use of midazolam for dental care in patients with intellectual disability is poorly documented. The purpose of this study was to determine which method of premedication is more effective for these patients, 0.15 mg/kg of intramuscular midazolam or 0.3 mg/kg of oral midazolam.
  
  
  METHODS
  This study was designed and implemented as a non-randomized retrospective study. The study population was composed of patients with intellectual disability who required dental treatment under ambulatory general anesthesia from August 2009 through April 2013. Patients were administered 0.15 mg/kg of midazolam intramuscularly (Group IM) or 0.3 mg/kg orally (Group PO). The predictor variable was the method of midazolam administration. The outcome variables measured were Observer's Assessment of Alertness/ Sedation (OAA/S) Scale scores, the level of cooperation when entering the operation room and for venous cannulation, post-anesthetic agitation and recovery time.
  
  
  RESULTS
  Midazolam was administered intramuscularly in 23 patients and orally in 21 patients. More patients were successfully sedated with no resistance behavior during venous cannulation in Group PO than in Group IM (p=0.034). There were no differences in demographic data and other variables between the groups.
  
  
  CONCLUSIONS
  The results of this study suggest that oral premedication with 0.3 mg/kg of midazolam is more effective than 0.15 mg/kg of midazolam administered intramuscularly, in terms of patient resistance to venous cannulation. If both oral and intramuscular routes of midazolam are acceptable in intellectually disabled patients, the oral route is recommended.
authors.affiliation: Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, 1-8, Yamadaoka, Suita, Osaka, Japan, hanamoto@dent.osaka-u.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Hanamoto
authors.forename: A
authors.initials: A
authors.lastname: Boku
authors.forename: M
authors.initials: M
authors.lastname: Sugimura
authors.forename: A
authors.initials: A
authors.lastname: Oyamaguchi
authors.forename: M
authors.initials: M
authors.lastname: Inoue
authors.forename: H
authors.initials: H
authors.lastname: Niwa
mesh_terms: D000284:Administration, Oral; D000768:Anesthesia, General; D003729:Dental Care; D006233:Persons with Disabilities; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007273:Injections, Intramuscular; D008874:Midazolam / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam