Abstract
ObjectivesTo describe the efficacy and safety of intranasal midazolam for sedation during essential dental treatment of geriatric patients with major neurocognitive disorder (MND) and care‐resistant behaviour (CRB).BackgroundDental treatment is often impossible in geriatric MND patients with CRB. Intranasal midazolam may provide a non‐invasive sedation method, but there is currently no information on its use in geriatric patients.MethodsIn this observational study, we included geriatric patients with severe MND and CRB needing urgent dental treatment. Each patient received 5 mg midazolam intranasally. Agitation/sedation levels, heart rate, respiration rate and oxygen saturation were recorded at 5‐minute intervals.ResultsThirty two patients were included. Mean age was 84 (±7) years. Mean (SD) time to treatment start was 13 (±5) minutes, and mean time to maximum sedation 17 (±11) minutes. Sedation was sufficient to enable dental treatment to be completed in 31 (97%) patients. Anxiolysis/light sedation occurred in 16 (50%) patients, and moderate to deep sedation occurred in 16 (50%) patients. No patients suffered from apnoea, although 3 patients required a chin‐lift manoeuvre. Hypoxaemia occurred in 1 of these patients and in 2 other patients without airway obstruction. All patients recovered uneventfully. In a regression model, age, weight and other sedative medication use were found not to be associated with maximum sedation depth.ConclusionsOf 5 mg intranasal midazolam facilitates treatment of geriatric patients with MND in the comfort of their own environment. More information is needed to guide titration to balance the desired sedation level and patient safety.
Highlights
The global population is ageing, and the incidence of major neurocognitive disorders (MND) such as Alzheimer's disease is increasing
The results will indicate whether intranasal midazolam can be safely used for this purpose and whether there are potential benefits and risks. This was an observational study of the use of intranasal midazolam for the sedation of geriatric patients who are living in nursing homes, suffering from MND and who display care-resistant behaviour during dental treatment in two northern regions in the Netherlands
We investigated the efficacy and safety of intranasal midazolam for sedation during dental procedures in 32 geriatric patients with MND and care-resistant behaviour
Summary
The global population is ageing, and the incidence of major neurocognitive disorders (MND) such as Alzheimer's disease is increasing. In people with MND, poor oral health causes painful oral conditions which often go undetected.[6,7] It is known that when these problems are detected and treated this has a positive impact on the quality of life.[8,9] In summary, poor dental health is a large, modifiable burden in the geriatric population causing many elderly patients to suffer from undetected chronic pain in the last days of their lives.6,10-12
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