Effectiveness of intra-rectal midazolam for sedation in pediatric dentistry

Objective: To evaluate the effectiveness of midazolam for concious sedation in children during dental treatment with regard to physiology and behaviour. Methods: 219 children (4.3±1.7y) who received routine dental treatment under sedation (intra-rectal Midazolam, 0.4mg/kg, in conjunction with 45%\ 55% N2O/O2) in a private practice participated in the study. Local anesthesia was administered by a computerized delivery system. 53 children received three concecutive sedations in 7-10 days interval. Results: Total of 329 sedations were analysed. Sedation onset was diagnosed after average of 5.6+2.4 minutes. 60.2% of the children cooperated during administraion of sedation, 9.6% cried, 18.8% and 11.2% showed slight or strong resistance, respectively. Most children (73%) recived treatment without any restrain, while 27% sat on their parents. Mean pulse before and at the end of treatment was 93+16 and 97+15, respectively (p<0.01). Percent saturation of hemoglobin was comparable before and at the end of the treatment ( 98+1 and 99+2, respectively). Behaviour durind anesthetic administration was very good, fair and low in 55% , 38% and 7% of the children, respectively (CHEOPS). Planned treatment was accomplished in 92% of the children. 4.5% of the children were refered to general anesthesia. Behaviour during treatment (Houpt scale) was rated as good to excellent in most of the children (87%). Mean cooperation score was 6.7+2. 3 children . No correlation was found between cooperation at treatment and age gender or previous experience of dental treatment. Children receiving restorations or sealants cooperated significantely better than children receiving crowns, extraction or root canal treatment. Cooperation during cosecutive appointments was significantely lower (6.5% and 5.7%, respectively), as compared to first appointment. 1.3%, 1.5% and 8.2% of the children had nistagmus, diplopia and hycuppes, respectively. Conclusion: Intra-rectal midazolam in conjunction with nitrous oxide is safe and effective sedation for dental treatment.