Abstract
PurposeTo assess the efficacy of midazolam for anxiety control in third molar extraction surgery.MethodsElectronic retrievals were conducted in Medline (via PubMed, 1950-2013.12), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3), Embase (via OVID 1974-2013.12), and the System for Information on Grey Literature in Europe (SIGLE). The bibliographies of relevant clinical trials were also checked. Randomized controlled trials satisfying the inclusion criteria were evaluated, with data extraction done independently by two well-trained investigators. Disagreements were resolved by discussion or by consultation with a third member of the review team.ResultsTen studies were included, but meta-analysis could not be conducted because of the significant differences among articles. All but one article demonstrated that midazolam could relieve anxiety. One article demonstrated that propofol offered superior anxiolysis, with more rapid recovery than with midazolam. Compared with lorazepam and diazepam, midazolam did not distinctly dominate in its sedative effect, but was safer. Two articles used midazolam in multidrug intravenous sedation and proved it to be more effective than midazolam alone.ConclusionIt was found, by comparison and analysis, that midazolam might be effective for use for anxiety control during third molar extraction and can be safely administered by a dedicated staff member. It can also be used with other drugs to obtain better sedative effects, but the patient’s respiratory function must be monitored closely, because multidrug sedation is also more risky.
Highlights
Dentistry and anxiety have always been inextricably linked, with regard to third molar extractions, which provide a relatively intense surgical stimulus
All but one article demonstrated that midazolam could relieve anxiety
Two articles used midazolam in multidrug intravenous sedation and proved it to be more effective than midazolam alone
Summary
Dentistry and anxiety have always been inextricably linked, with regard to third molar extractions, which provide a relatively intense surgical stimulus. Anxiety toward dental procedures varies from a suppressed fear of pain to a phobia. Patients may have symptoms such as sweating, tremors, arrhythmias, and vasovagal reactions, which may make treatment difficult or even impossible. Sedative measures have attracted serious attention among dental practitioners and researchers. “Minimal sedation” or “anxiolysis” is a drug-induced condition in which patients respond normally to verbal commands, while the cardiovascular systems and spontaneous breathing are unaffected. Cognitive function and coordination may be impaired [1]
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