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A comparison of the sedative effect of oral versus nasal midazolam combined with nitrous oxide in uncooperative children.
Eur Arch Paediatr Dent. 2015 Oct; 16(5):417-24.EA

Abstract

AIM

To compare a combination of oral midazolam (0.2 mg/kg body weight) and nitrous oxide-oxygen sedation with a combination of intranasal midazolam (0.1 mg/kg body weight) and nitrous oxide-oxygen sedation for effectiveness, patient acceptability and safety profile in controlling the behaviour of uncooperative children.

METHODS

Thirty children, 4-10 years of age, referred for dental treatment were included in the study with a crossover design. Each patient was sedated with a combination of either oral midazolam and nitrous oxide-oxygen sedation or intranasal midazolam and nitrous oxide-oxygen sedation at subsequent dental treatment visits. During the treatment procedure, the study recorded scales for drug acceptability, onset of sedation, acceptance of nasal mask, sedation, behavioural, safety, overall behaviour and alertness.

RESULTS

The grade of acceptability of midazolam in both groups was consistently good. There was a significant difference (p < 0.001) in the time of onset of sedation, which was significantly quicker with the intranasal administration of midazolam. The mean time of onset for oral midazolam was 20.1 (17-25) min and for intranasal midazolam 12.1 (8-18) min. The efficacy profile of the present study included: acceptance of nasal mask, sedation score, crying levels, motor movements and overall behaviour scores. The results did not show any statistically significant differences. All the parameters were highly satisfactory. The difference in alertness was statistically significant (p value <0.05), being higher in the intranasal group than the oral group and suggestive of faster recovery using intranasal midazolam.

CONCLUSION

The intranasal route of midazolam administration has a quick onset of action and a quick recovery of the patient from sedation as compared to the oral route of midazolam administration. Midazolam administered through the intranasal route is as effective as the oral route at a lower dosage. Therefore, it is an effective alternative to oral route for a paediatric dental situation.

Authors+Show Affiliations

Department of Pediatric and Preventive Dentistry, M.A. Rangoonwala Dental College and Research Centre, Pune, 2390-B, K.B. Hidayatullah Road, Azam Campus, Camp, Pune, 411001, Maharashtra, India.Department of Pediatric and Preventive Dentistry, M.A. Rangoonwala Dental College and Research Centre, Pune, 2390-B, K.B. Hidayatullah Road, Azam Campus, Camp, Pune, 411001, Maharashtra, India. neha.chandan@hotmail.com.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

25939638

Citation

Musani, I E., and N V. Chandan. "A Comparison of the Sedative Effect of Oral Versus Nasal Midazolam Combined With Nitrous Oxide in Uncooperative Children." European Archives of Paediatric Dentistry : Official Journal of the European Academy of Paediatric Dentistry, vol. 16, no. 5, 2015, pp. 417-24.
Musani IE, Chandan NV. A comparison of the sedative effect of oral versus nasal midazolam combined with nitrous oxide in uncooperative children. Eur Arch Paediatr Dent. 2015;16(5):417-24.
Musani, I. E., & Chandan, N. V. (2015). A comparison of the sedative effect of oral versus nasal midazolam combined with nitrous oxide in uncooperative children. European Archives of Paediatric Dentistry : Official Journal of the European Academy of Paediatric Dentistry, 16(5), 417-24. https://doi.org/10.1007/s40368-015-0187-7
Musani IE, Chandan NV. A Comparison of the Sedative Effect of Oral Versus Nasal Midazolam Combined With Nitrous Oxide in Uncooperative Children. Eur Arch Paediatr Dent. 2015;16(5):417-24. PubMed PMID: 25939638.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of the sedative effect of oral versus nasal midazolam combined with nitrous oxide in uncooperative children. AU - Musani,I E, AU - Chandan,N V, Y1 - 2015/05/05/ PY - 2015/02/03/received PY - 2015/03/26/accepted PY - 2015/5/6/entrez PY - 2015/5/6/pubmed PY - 2016/1/15/medline KW - Behaviour management KW - Intranasal midazolam KW - Local anaesthetic KW - Nitrous oxide KW - Oral midazolam KW - Uncooperative children SP - 417 EP - 24 JF - European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry JO - Eur Arch Paediatr Dent VL - 16 IS - 5 N2 - AIM: To compare a combination of oral midazolam (0.2 mg/kg body weight) and nitrous oxide-oxygen sedation with a combination of intranasal midazolam (0.1 mg/kg body weight) and nitrous oxide-oxygen sedation for effectiveness, patient acceptability and safety profile in controlling the behaviour of uncooperative children. METHODS: Thirty children, 4-10 years of age, referred for dental treatment were included in the study with a crossover design. Each patient was sedated with a combination of either oral midazolam and nitrous oxide-oxygen sedation or intranasal midazolam and nitrous oxide-oxygen sedation at subsequent dental treatment visits. During the treatment procedure, the study recorded scales for drug acceptability, onset of sedation, acceptance of nasal mask, sedation, behavioural, safety, overall behaviour and alertness. RESULTS: The grade of acceptability of midazolam in both groups was consistently good. There was a significant difference (p < 0.001) in the time of onset of sedation, which was significantly quicker with the intranasal administration of midazolam. The mean time of onset for oral midazolam was 20.1 (17-25) min and for intranasal midazolam 12.1 (8-18) min. The efficacy profile of the present study included: acceptance of nasal mask, sedation score, crying levels, motor movements and overall behaviour scores. The results did not show any statistically significant differences. All the parameters were highly satisfactory. The difference in alertness was statistically significant (p value <0.05), being higher in the intranasal group than the oral group and suggestive of faster recovery using intranasal midazolam. CONCLUSION: The intranasal route of midazolam administration has a quick onset of action and a quick recovery of the patient from sedation as compared to the oral route of midazolam administration. Midazolam administered through the intranasal route is as effective as the oral route at a lower dosage. Therefore, it is an effective alternative to oral route for a paediatric dental situation. SN - 1818-6300 UR - https://www.unboundmedicine.com/medline/citation/25939638/A_comparison_of_the_sedative_effect_of_oral_versus_nasal_midazolam_combined_with_nitrous_oxide_in_uncooperative_children_ L2 - https://dx.doi.org/10.1007/s40368-015-0187-7 DB - PRIME DP - Unbound Medicine ER -