A comparative evaluation of oral midazolam with other sedatives as premedication in pediatric dentistry

The purpose of present study was to evaluate the safety and efficacy of orally administered midazo-lam in children as a sedative agent and to compare it with two other older agents, triclofos and promet-hazine. The study was conducted on ninety child patients requiring some short dental procedure. All the patients were with a good physical status (ASA-I). The ages ranged between 3 and 9 years. The patients were randomized into three study groups: Group 1, midazolam, Group II, triclofos and Group III, promethazine, on the basis of the drugs to be administered. After administration of drugs in each group, the effects were evaluated in terms of onset of action, sedative effect, ease of treatment completion, recovery time and postoperative amnesia. Midazolam was found to be the best drug among the three to produce conscious sedation in children.

1. Stouthard MBA, Hoogstratin, J. Prevalence of dental anxiety in Netherlands. Comm Dent Oral Edpidemiol 18: 139–42, 1990.

2. Milgrom P, Mane L, King B. Origins of childhood dental fear. Belzav Res Fiber 33: 313–9, 1995

3. Lindgren L, Saarnivaara L, Hiinberg JJ. Comparison of oral triclofos, diazepam and flunitrazepam as premedicants in childrden undergo-ing otolaryngological surgery. Brit J Anaesth 52: 283–90, 1980.

4. Jackson EA, Rabbette PS, Dezateux C, Hatch DJ, Stocks J. The effect of triclofos sodium on respiratory rate, oxygen saturation and heart rate in infants and young children. Pediatric Pul-monology 10: 40–5, 1991.

5. Solomon AL,Lowell RJ.Promethazine as an adjunct to the treatment of the problem dental patient. NY State Dent 24: 348–353, 1958.

6. Stuebner EA, Sandove MS. The use of promethazine for pre-medication. J Am Dent Soc Anesth 5: 12–18, 1958.

7. Weiss WA, Mc Cree JP, Jr. Promethazine as adjunct to preopera-tive medication. Ann Surg 144: 861–864, 1956.

8. Roelofse JA, Loun IR, Roelofse PG. A double blind randomized comparison of oral triineprazine-methadone and ketamine-midazolam for sedation of paediatric dental patients for oral sur-gical procedures. Anaesthesia Progress 45: 3–11, 1998.

9. Silver T, Wilson C, Webb M. Evaluation of two dosages of oral midazolam as a conscious sedation for physically and neurologi-cally compromised paediatric dental patients. Pediatr Dent 16: 350–9, 1994.

10. Gallardo F, Cornejo G, Bode R. Oral midazolam as premedica-tion for the apprehensive child before dental treatment. J Clin Pediatr Dent 18:123–7, 1994.

11. Levine MF, Spahr-Schopfer TA, Hartley F, Derman J, Mac Pher-son R. Oral midazolam premedication in children: the minimum time interval for separation from parents. Canadian J Anaesthe-sia 40: 726–9, 1993.

12. Davies FC,Waters M. Oral midazolam for conscious sedation of chil-dren during minor procedures.J Accident Emerg Med 15:244–8,1998.

13. Talksdorf W, Bremerich D, Nordmeyer U. Midazolam for pre-medication of infants: A comparison of the effect between oral and rectal administration. Anaesthesie Intensivtherapie Not-fallmedizin 24: 355–61, 1989.

14. Balakrishnan K, Panchal ID, Talwalkar L, Kamath SK, Suri YV, Jalali RK, Singh B, Gowrishankar R, Bagati A. A comparative evaluation of midazolam and diazepam as preoperative medica-tion. Ind J Ana 42: 33, 1998.

15. Zuora KL. Midazolam in emergency surgery - a pilot study on adult Nigerian patients. West African J Med 13: 70–2, 1994.

16. Malinovsky JM, Populaire C, Cozain A, Lepage JY, Lejus C, Pinand M. Premedication with midazolam in children. Effect of intranasal, rectal and oral routes on plasma midazolam concen-trations. Anaesthesia 50: 35–4, 1995.

17. Shane SA, Fuchs SM, Khine H. Efficacy of rectal midazolam for the sedation of preschool children undergoing laceration repair. Annals Emergency Med 24: 1065–73, 1994.

18. Van Eugelen BG, Gimbrere JS, Booy IH. Benzodiazepine withdrawal reactions in two children following discontinuation of sedation with midazolam. Annals Pharmacotheraphy 27: 579–81, 1993.

19. Orwin JM, Schroeder JD. Safety of choral. Br Med J 3: 187, 1968.

20. Chan-Tack, KM. Nueroleptic malignant syndrome due to promethazine. S Med J 92: 1017–8, 1999.