Assessment of Intranasal Midazolam Administration with a Dose of 0.5 mg/ Kg in Behavior Management of Uncooperative Children

Aim: Intranasal midazolam has been used to induce conscious sedation in children with negative and aggressive behavior. The main goal of this study was to determine the effectiveness of intranasal administration of midazolam (with a dose of 0.5 mg/kg) in behavior management of uncooperative children. Materials and methods: Thirty healthy, difficult children of 3-5 years were evaluated. At the beginning of each session, ordinary techniques of behavior management to treat patients were applied. In cases of unsatisfactory responses, intranasal midazolam was immediately employed. To determine the efficacy of the drug,child behavior was evaluated before and after administration of midazolam using Houpt rating scale of general behavior. Results: A statistically significant difference was demonstrated in the patients' behavior before and after administration of intranasal midazolam. Conclusions: this drug is effective in sedation and reduction of the anxiety of children under treatment.

Intranasal midazolam, Pediatric dentistry, Conscious sedation

1. McDonald R, Avery D. Dentistry for the child and Adolescent. 8th ed. St Louis: MosbyCo, 287–331, 2004.

2. A1-Rakaf H, Bello LL, Turkustani A, Adenubi JO. Intra-nasal midazo-lam in conscious sedation of young paediatric dental patients. Int J Ped Dent,11(1): 33–40, 2001.

3. American Academy of Pediatric Dentistry (AAPD). Guidelines for the elective use of pharmacologic conscious sedation and deep sedation in pediatric dental patients. Reference Manual. Pediatric Dentistry, 48–52, 1997–98.

4. Kronish J, Grouper M. Conscious sedation. 1 st ed. Philadelphia: Han-ley and Belfus Inc., 2001.

5. Cote, Todres, Goudsouzian, Ryan. A practice of anesthesia for infants and children. Philadelphia: WB Saunders Co., 2001.

6. Kupietzky A, Houpt MI. Midazolam: a review of its use for conscious sedation of children. Ped Dent, 15(4): 237–41, 1993.

7. Wynn R, Holroyd S. Clinical pharmacology in dental practice. 4th ed. St Louis: Mosby, 82–90, 1998.

8. Ochs MW, Tucker MR, White RP. A comparison of amnesia in outpa-tients sedated with midazolam or diazepam alone or in combination with fentany1 during oral surgery. J Am Dent Assoc, 113(6): 894–7, 1986.

9. McCloy RF, Pearson RC. Which agent and how to deliver it? A review of benzodiazepine sedation and its reversal in endoscopy. Scand J Gas-troenterol Supple, 179(1): 7–11, 1990.

10. Meechan J, Robb N, Seymour R. Pain and anxiety control for the con-scious dental patient. 1st ed. New York: Oxford, 1998.

11. Barash P, Cullen B, Stoelting R. Clinical anesthesia, 4th ed. Philadel-phia: Lippincott, Willing and Wilkins, 2001.

12. Nathan JE. Behavioral management strategies for young pediatric den-tal patients with disabilities. ASDC J Dent Child, 68(2): 89–101, 2001.

13. Fukuta O, Braham RL, Yanase H, Atsumi N, Kurosu K. The sedative effect of intranasal midazolam administration in the dental treatment of patients with mental disabilities Part 1. The effect of a 0.2mg/kg dose. J Clin Pediat Dent, 17(4): 231–7, 1993.

14. Fukuta O, Braham RL, Yanase H, Kurosu K. The sedative effects of nasal midazolam administration in the dental treatment of patients with mental disabilities. Part 2. Optimal concentration of intranasal midazo-lam. J Clin Ped Dent, 18(4): 259–65, 1994.

15. Fuks AB, Kaufman E, Ram D, Hovav S, Shapira J. Assessment of two doses of intranasal midazolam for sedation of young pediatric dental patients. Ped Dent, 16(4): 301–5, 1994.

16. Fukuta O, Braham RL, Yanase H, Kurosu K. Intranasal administration of midazolam: pharmacokinetic and pharmacodynamic properties and sedative potential. ASDC J Dent Child, 64(2): 89–98, 1997.

17. Miller RD. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone Co., 2000.

18. Lioyd CJ, Alredy T, Lowry JC. Intranasal midazolam as an alternative to general anesthesia in the management of children with oral and max-illofacial trauma. Br J Oral Maxillofac Surg, 38(6): 593–5, 2000.

19. Abrams R, Morrison JE. Safety and effectiveness of intranasal admin-istration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures. Anesth Prog, 40(3): 63–6, 1993.