Conscious sedation procedures using intravenous midazolam for dental care in patients with different cognitive profiles: a prospective study of effectiveness and safety

Valérie Collado, Denise Faulks, Emmanuel Nicolas, Martine Hennequin, Valérie Collado, Denise Faulks, Emmanuel Nicolas, Martine Hennequin

Abstract

The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂), were shown to be safe and effective in patients with intellectual disability when administered by dentists.

Trial registration: ClinicalTrials.gov NCT01874717.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Comparison of cooperation scores between…
Figure 1. Comparison of cooperation scores between both groups during dental treatment.
The distribution of the three levels of Venham score, at each time point and for each group. Ti: At first contact with the dentist; T0: During venous cannulation; T1: At the end of the induction; T2: During the first injection of local anaesthesia; T3: At the moment of least cooperation during initial dental treatment. DA: Group of patients with Dental anxiety disorder; ID: group of patients with Intellectual Disability. *** = significant difference between the two groups of patients (p

Figure 2. Influence of IV midazolam repetition…

Figure 2. Influence of IV midazolam repetition on cooperation scores in both groups.

The distribution…

Figure 2. Influence of IV midazolam repetition on cooperation scores in both groups.
The distribution of the three levels of Venham score, at each time point and for each group, in relation to the session being a first experience of sedation (First exp.) or a repeat session (Reit.). Ti: At first contact with the dentist; T0: During venous cannulation; T1: At the end of the induction; T2: During the first injection of local anaesthesia; T3: At the moment of least cooperation during initial dental treatment. DA: Group of patients with Dental Anxiety disorder; ID: group of patients with Intellectual Disability. Significant difference between the two groups of patients, Fisher exact test: *** = p
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References
    1. Allison PJ, Hennequin M, Faulks D (2000) Dental care access among individuals with Down syndrome in France. Spec Care Dentist 20: 28–34. - PubMed
    1. Collado V, Hennequin M, Faulks D, Mazille M-N, Nicolas E, et al. (2006) Modification of behavior with 50% nitrous oxide/oxygen conscious sedation over repeated visits for dental treatment a 3-year prospective study. J Clin Psychopharmacol 26: 474–481. - PubMed
    1. Runes J, Ström C (1996) Midazolam intravenous conscious sedation in oral surgery. A retrospective study of 372 cases. Swed Dent J 20: 29–33. - PubMed
    1. Erlandsson AL, Bäckman B, Stenström A, Stecksén-Blicks C (2001) Conscious sedation by oral administration of midazolam in paediatric dental treatment. Swed Dent J 25: 97–104. - PubMed
    1. Padmanabhan U, Leslie K, Eer AS, Maruff P, Silbert BS (2009) Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol. Anesth Analg 109: 1448–1455. - PubMed
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The study was financed by a 2004 local hospital medical research fund (Projet Hospitalier de Recherche Clinique). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Figure 2. Influence of IV midazolam repetition…
Figure 2. Influence of IV midazolam repetition on cooperation scores in both groups.
The distribution of the three levels of Venham score, at each time point and for each group, in relation to the session being a first experience of sedation (First exp.) or a repeat session (Reit.). Ti: At first contact with the dentist; T0: During venous cannulation; T1: At the end of the induction; T2: During the first injection of local anaesthesia; T3: At the moment of least cooperation during initial dental treatment. DA: Group of patients with Dental Anxiety disorder; ID: group of patients with Intellectual Disability. Significant difference between the two groups of patients, Fisher exact test: *** = p

References

    1. Allison PJ, Hennequin M, Faulks D (2000) Dental care access among individuals with Down syndrome in France. Spec Care Dentist 20: 28–34.
    1. Collado V, Hennequin M, Faulks D, Mazille M-N, Nicolas E, et al. (2006) Modification of behavior with 50% nitrous oxide/oxygen conscious sedation over repeated visits for dental treatment a 3-year prospective study. J Clin Psychopharmacol 26: 474–481.
    1. Runes J, Ström C (1996) Midazolam intravenous conscious sedation in oral surgery. A retrospective study of 372 cases. Swed Dent J 20: 29–33.
    1. Erlandsson AL, Bäckman B, Stenström A, Stecksén-Blicks C (2001) Conscious sedation by oral administration of midazolam in paediatric dental treatment. Swed Dent J 25: 97–104.
    1. Padmanabhan U, Leslie K, Eer AS, Maruff P, Silbert BS (2009) Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol. Anesth Analg 109: 1448–1455.
    1. Wood M (2010) The safety and efficacy of intranasal midazolam sedation combined with inhalation sedation with nitrous oxide and oxygen in paediatric dental patients as an alternative to general anaesthesia. SAAD Dig 26: 12–22.
    1. General dental council (2005) Standards for dental professionals. General dental council website. Available: . Accessed 2013 July 08.
    1. Lindh-Strömberg U (2001) Rectal administration of midazolam for conscious sedation of uncooperative children in need of dental treatment. Swed Dent J 25: 105–111.
    1. Wilson KE, Girdler NM, Welbury RR (2003) Randomized, controlled, cross-over clinical trial comparing intravenous midazolam sedation with nitrous oxide sedation in children undergoing dental extractions. Br J Anaesth 91: 850–856.
    1. Primosch RE, Guelmann M (2005) Comparison of drops versus spray administration of intranasal midazolam in two- and three-year-old children for dental sedation. Pediatr Dent 27: 401–408.
    1. Wilson KE, Girdler NM, Welbury RR (2006) A comparison of oral midazolam and nitrous oxide sedation for dental extractions in children. Anaesthesia 61: 1138–1144.
    1. Lourenço-Matharu L, Roberts GJ (2010) Oral sedation for dental treatment in young children in a hospital setting. Br Dent J 209: E12.
    1. Folayan M, Faponle A, Lamikanra A (2002) Seminars on controversial issues. A review of the pharmacological approach to the management of dental anxiety in children. Int J Paediatr Dent 12: 347–354.
    1. Bavisha KA, Elias M, Paris S, Leon AR, Flynn PJ (2004) Comparison of patient-controlled and operator-controlled conscious sedation for restorative dentistry. Eur J Anaesthesiol 21: 284–288.
    1. Wilson KE, Thorpe RJ, McCabe JF, Girdler NM (2011) Complications associated with intravenous midazolam sedation in anxious dental patients. Prim Dent Care 18: 161–166.
    1. Academy of medical royal college (2001) Implementing and Ensuring Safe Sedation Practice for Healthcare in Adults. Report of an Intercollegiate Working party chaired by the Royal College of Anaesthesists.
    1. Scottish Intercollegiate Guidelines Network (2002). Safe Sedation of Children undergoing Diagnostic and Therapeutic procedures. A national clinical guideline.
    1. Craig DC, Wildsmith JAW (2007) Conscious sedation for dentistry: an update. Br Dent J 203: 629–631 doi:
    1. The Royal College of Anaesthetists (2007) Standards for conscious sedation in dentistry: alternative techniques. A report from the Standing Commitee on Sedation for Dentistry.
    1. Glassman P (2009) A review of guidelines for sedation, anesthesia,and alternative interventions for people with special needs. Spec Care Dentist 29: 9–16.
    1. Woolley SM, Hingston EJ, Shah J, Chadwick BL (2009) Paediatric conscious sedation: views and experience of specialists in paediatric dentistry. Br Dent J 207: E11; discussion 280–281.
    1. Capp PL, de Faria ME, Siqueira SR, Cillo MT, Prado EG, et al. (2010) Special care dentistry: Midazolam conscious sedation for patients with neurological diseases. Eur J Paediatr Dent 11: 162–164.
    1. Fukuta O, Braham RL, Yanase H, Atsumi N, Kurosu K (1993) The sedative effect of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 1. The effect of a 0.2 mg/kg dose. J Clin Pediatr Dent 17: 231–237.
    1. Silver T, Wilson C, Webb M (1994) Evaluation of two dosages of oral midazolam as a conscious sedation for physically and neurologically compromised pediatric dental patients. Pediatr Dent 16: 350–359.
    1. Uldum B, Hallonsten A-L, Poulsen S (2008) Midazolam conscious sedation in a large Danish municipal dental service for children and adolescents. Int J Paediatr Dent 18: 256–261.
    1. Johnson E, Briskie D, Majewski R, Edwards S, Reynolds P (2010) The physiologic and behavioral effects of oral and intranasal midazolam in pediatric dental patients. Pediatr Dent 32: 229–238.
    1. Wood M (2011) The safety and efficacy of using a concentrated intranasal midazolam formulation for paediatric dental sedation. SAAD Dig 27: 16–23.
    1. Averley PA, Girdler NM, Bond S, Steen N, Steele J (2004) A randomised controlled trial of paediatric conscious sedation for dental treatment using intravenous midazolam combined with inhaled nitrous oxide or nitrous oxide/sevoflurane. Anaesthesia 59: 844–852.
    1. Lourenco-Matharu L, Roberts GJ (2011) Effectiveness and acceptability of intravenous sedation in child and adolescent dental patients: report of a case series at King’s College Hospital, London. Br Dent J 210: 567–572.
    1. Manley MCG, Ransford NJ, Lewis DA, Thompson SA, Forbes M (2008) Retrospective audit of the efficacy and safety of the combined intranasal/intravenous midazolam sedation technique for the dental treatment of adults with learning disability. Br Dent J 205: E3; discussion 84–85.
    1. Ransford NJ, Manley MCG, Lewis DA, Thompson SA, Wray LJ, et al. (2010) Intranasal/intravenous sedation for the dental care of adults with severe disabilities: a multicentre prospective audit. Br Dent J 208: 565–569.
    1. American Society of Anaesthesiologists (1963) New classification of physical status. Anaesthesiology 24: 111.
    1. Veerkamp JS, Gruythuysen RJ, Hoogstraten J, van Amerongen WE (1993) Dental treatment of fearful children using nitrous oxide. Part 4: Anxiety after two years. ASDC J Dent Child 60: 372–376.
    1. Hennequin M, Faulks D, Collado V, Thellier E, Nicolas E (2007) French version of two indices of dental anxiety and patient cooperation. Eur Cell Mater 13: 38.
    1. McKenna G, Manton S (2008) Pre-operative fasting for intravenous conscious sedation used in dental treatment: are conclusions based on relative risk management or evidence? Br Dent J 205: 173–176.
    1. Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. Br Med J 2: 656–659.
    1. Hennequin M, Manière M-C, Albecker-Grappe S, Faulks D, Berthet A, et al. (2004) A prospective multicentric trial for effectiveness and tolerance of a N2O/O2 premix used as a sedative drug. J Clin Psychopharmacol 24: 552–554.
    1. Collado V, Faulks D, Hennequin M (2008) A survey of the difficulties encountered during routine hygiene and health care by persons with special needs. Disabil Rehabil 30: 1047–1054.
    1. Al-Zahrani AM, Wyne AH, Sheta SA (2009) Comparison of oral midazolam with a combination of oral midazolam and nitrous oxide-oxygen inhalation in the effectiveness of dental sedation for young children. J Indian Soc Pedod Prev Dent 27: 9–16.
    1. Baygin O, Bodur H, Isik B (2010) Effectiveness of premedication agents administered prior to nitrous oxide/oxygen. Eur J Anaesthesiol 27: 341–346.
    1. Isik B, Baygin O, Kapci E, Bodur H (2010) The effects of temperament and behaviour problems on sedation failure in anxious children after midazolam premedication. Eur J Anaesthesiol 27: 336–340.
    1. Venchard GR, Thomson PJ, Boys R (2006) Improved sedation for oral surgery by combining nitrous oxide and intravenous Midazolam: a randomized, controlled trial. International Journal of Oral and Maxillofacial Surgery 35: 522–527.
    1. Miyawaki T, Kohjitani A, Maeda S, Egusa M, Mori T, et al. (2004) Intravenous sedation for dental patients with intellectual disability. J Intellect Disabil Res 48: 764–768.
    1. Coke JM, Edwards MD (2009) Minimal and moderate oral sedation in the adult special needs patient. Dent Clin North Am 53: 221–230.

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