Safety and physiologic effects of intranasal midazolam and nitrous oxide inhalation based sedation in children visiting Saveetha Dental College and Hospitals, India.

Neethu Ann Preethy

doi:10.6026/97320630018026

Abstract

A large number of patients avoid dental care due to anxiety. Various techniques are available for behaviour related management. Therefore, safety and physiologic effects of intranasal midazolam and nitrous oxide inhalation based sedation in children aged 4 to 8 years visiting Saveetha Dental College and Hospitals, India is of interest. 35 anxious patients aged 4 to 8 years were included in the study. The patient received either intranasal midazolam/nitrous oxide in the first visit and vice versa at the second visit. The onset of sedation, recovery time and procedure duration were recorded using a timer. Physiological parameters were recorded using a monitor. Safety scale was used for assessing prevalence of adverse reactions. There was no significant difference between the groups in safety scale scores, recovery time and procedure duration. Midazolam group showed a statistically significant faster onset of sedation and a statistically significant increase in heart rate at four recorded time-points. All the vitals were within the physiological limits. Thus, intranasal midazolamis a safe alternative to nitrous-oxide sedation in completing the intended dental treatment while managing the anxious children in dental clinic.

Highlights

Dental fear and anxiety prevail to be a major obstacle for paediatric dentists in rendering successful treatment to children as it impedes, or even precludes the quality of dental care to be provided [1,2]
The main advantage of using pharmacological behaviour management is the decreased interruption of the dental treatment exhibited by the child experiencing behaviour management problems[7].Several factors play a role in the decision upon the type of pharmacological behaviour management to be provided such as age of the patient, pre-operative anxiety, extent of patient’s dental needs, risk involved with pharmacological management, safety, parental expectation and cost [8]
*p< 0.05 showing statistically significant difference; Table showing the comparison of onset of sedation and onset of satisfactory sedation between nitrous oxide sedation and intranasal midazolam sedation with a statistically significant difference at p

Summary

Introduction

Dental fear and anxiety prevail to be a major obstacle for paediatric dentists in rendering successful treatment to children as it impedes, or even precludes the quality of dental care to be provided [1,2]. It was observed in a study that 60% of the children who were experiencing dental fear presented with behaviour management problems, out of which 25% of children were experiencing anxiousness [4]. The main advantage of using pharmacological behaviour management is the decreased interruption of the dental treatment exhibited by the child experiencing behaviour management problems[7].Several factors play a role in the decision upon the type of pharmacological behaviour management to be provided such as age of the patient, pre-operative anxiety, extent of patient’s dental needs, risk involved with pharmacological management, safety, parental expectation and cost [8]. AAPD has formulated goals and given guidelines for using basic and advanced techniques in managing paediatric dental patients [9,10]

Methods

Results

Discussion

Conclusion