Abstract
BackgroundThe 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.Material and MethodsThis 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.ResultsMidazolam 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.ConclusionsThe 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. Key words:Premedication, midazolam, intellectual disability.
Highlights
The number of people with special needs who require oral health services is increasing [1]
This study was performed according to the Declaration of Helsinki and approved by the institutional review board and ethics committee of Osaka University Dental Hospital (H26-E50). - Patients The study population was composed of patients with intellectual disability receiving dental treatment under ambulatory general anesthesia from August 2009 through April 2013
The main finding of this study was that 0.3 mg/kg of oral midazolam was more effective in facilitating intravenous cannulation than 0.15 mg/kg of intramuscular midazolam
Summary
The number of people with special needs who require oral health services is increasing [1]. Since general anesthesia for such patients is usually given in an ambulatory setting in which rapid recovery is required, the route of administration of the premedicant is important Several drugs, such as ketamine [2], clonidine [3] and dexmedetomidine [4,5], are used as sedative premedication in pediatric patients, midazolam is one of the most popular sedatives. 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
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