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Effect of submucosal midazolam on behavior and physiologic response when combined with oral chloral hydrate and nitrous oxide sedation.
Pediatr Dent. 2004 Jan-Feb; 26(1):37-43.PD

Abstract

PURPOSE

This study was designed to examine the efficacy and safety of submucosal (SM) midazolam and oral chloral hydrate (CH) when used for pediatric conscious sedation in a clinical dental environment.

METHODS

Twenty children ages 32 to 63 months participated in this institutionally approved study. Selection criteria included good health (ASA I), 2 to 5 years of age, uncooperative behavior, and the need for multiple restorative visits. In a double-blind crossover design, patients were randomly assigned to receive either oral CH (50 mg/kg) and SM midazolam (0.2 mg/kg), or oral CH (50 mg/kg) and SM saline placebo on their first sedation visit. On the second sedation visit, the patient received the opposite drug regimen than the first visit. Nitrous oxide (50%) was used during each sedation visit. Behavior response was rated as quiet (Q), crying (C), movement (M), or struggling (S) every 2.5 minutes through 40 minutes of operative procedures. Sedations were monitored using a capnograph, pulse oximeter, an automated blood pressure cuff, and precordial stethoscope. Respiratory rate (RR), heart rate (HR), and blood pressure (BP) were evaluated for each procedure. Data was analyzed using ANOVA and multinomial repeated-measures logistic regression.

RESULTS

Analysis showed a significant difference in behavior during sedation across drug regimen (chi-square = 55.6, df = 3, P < .0001). Patients given SM midazolam in addition to oral CH showed increased Q rating and decreased C, M, and S ratings. RR, BP, and HR for both groups remained within the normal values for 2- to 5-year-olds.

CONCLUSIONS

SM midazolam improved the quality of sedation without compromising safety. Quiet behavior was increased and struggling behavior was decreased. In addition, mean HR, RR, and BP analysis did not deviate from the norm for this age group.

Authors+Show Affiliations

Department of Pediatric Dentistry, Virginia Commonwealth University, Medical College of Virginia, Richmond, Va, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15080356

Citation

Myers, Gary R., et al. "Effect of Submucosal Midazolam On Behavior and Physiologic Response when Combined With Oral Chloral Hydrate and Nitrous Oxide Sedation." Pediatric Dentistry, vol. 26, no. 1, 2004, pp. 37-43.
Myers GR, Maestrello CL, Mourino AP, et al. Effect of submucosal midazolam on behavior and physiologic response when combined with oral chloral hydrate and nitrous oxide sedation. Pediatr Dent. 2004;26(1):37-43.
Myers, G. R., Maestrello, C. L., Mourino, A. P., & Best, A. M. (2004). Effect of submucosal midazolam on behavior and physiologic response when combined with oral chloral hydrate and nitrous oxide sedation. Pediatric Dentistry, 26(1), 37-43.
Myers GR, et al. Effect of Submucosal Midazolam On Behavior and Physiologic Response when Combined With Oral Chloral Hydrate and Nitrous Oxide Sedation. Pediatr Dent. 2004 Jan-Feb;26(1):37-43. PubMed PMID: 15080356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of submucosal midazolam on behavior and physiologic response when combined with oral chloral hydrate and nitrous oxide sedation. AU - Myers,Gary R, AU - Maestrello,Christopher L, AU - Mourino,Arthur P, AU - Best,Al M, PY - 2004/4/15/pubmed PY - 2004/5/5/medline PY - 2004/4/15/entrez SP - 37 EP - 43 JF - Pediatric dentistry JO - Pediatr Dent VL - 26 IS - 1 N2 - PURPOSE: This study was designed to examine the efficacy and safety of submucosal (SM) midazolam and oral chloral hydrate (CH) when used for pediatric conscious sedation in a clinical dental environment. METHODS: Twenty children ages 32 to 63 months participated in this institutionally approved study. Selection criteria included good health (ASA I), 2 to 5 years of age, uncooperative behavior, and the need for multiple restorative visits. In a double-blind crossover design, patients were randomly assigned to receive either oral CH (50 mg/kg) and SM midazolam (0.2 mg/kg), or oral CH (50 mg/kg) and SM saline placebo on their first sedation visit. On the second sedation visit, the patient received the opposite drug regimen than the first visit. Nitrous oxide (50%) was used during each sedation visit. Behavior response was rated as quiet (Q), crying (C), movement (M), or struggling (S) every 2.5 minutes through 40 minutes of operative procedures. Sedations were monitored using a capnograph, pulse oximeter, an automated blood pressure cuff, and precordial stethoscope. Respiratory rate (RR), heart rate (HR), and blood pressure (BP) were evaluated for each procedure. Data was analyzed using ANOVA and multinomial repeated-measures logistic regression. RESULTS: Analysis showed a significant difference in behavior during sedation across drug regimen (chi-square = 55.6, df = 3, P < .0001). Patients given SM midazolam in addition to oral CH showed increased Q rating and decreased C, M, and S ratings. RR, BP, and HR for both groups remained within the normal values for 2- to 5-year-olds. CONCLUSIONS: SM midazolam improved the quality of sedation without compromising safety. Quiet behavior was increased and struggling behavior was decreased. In addition, mean HR, RR, and BP analysis did not deviate from the norm for this age group. SN - 0164-1263 UR - https://www.unboundmedicine.com/medline/citation/15080356/Effect_of_submucosal_midazolam_on_behavior_and_physiologic_response_when_combined_with_oral_chloral_hydrate_and_nitrous_oxide_sedation_ L2 - https://www.ingentaconnect.com/openurl?genre=article&amp;issn=0164-1263&amp;volume=26&amp;issue=1&amp;spage=37&amp;aulast=Myers DB - PRIME DP - Unbound Medicine ER -