Browse > Article

Administration order of midazolam/fentanyl for moderate dental sedation  

Lobb, Douglas (Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta)
Clarke, Alix (Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta)
Lai, Hollis (Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta)
Publication Information
Journal of Dental Anesthesia and Pain Medicine / v.18, no.1, 2018 , pp. 47-56 More about this Journal
Background: The purpose of this study is to investigate the effects of administration order when a sedative drug (midazolam) and an opioid analgesic drug (fentanyl) is applied for moderate intravenous (IV) sedation in dentistry. Methods: A retrospective chart review was conducted in one dental clinic during its transition from a midazolam-first to a fentanyl-first protocol for dental procedures requiring moderate IV sedation. Physiological parameters, drug administration times, patient recovery times, drug dosages, and patient recall and satisfaction were investigated for differences. Results: A total of 76 charts (40 midazolam-first and 36 fentanyl-first administrations), were used in the analysis. Administering midazolam first resulted in an average 4.38 min (52%) decrease in administration times (P < 0.001), and a decrease in procedural recollection immediately following the procedure (P = 0.03), and 24 to 48 hours later (P = 0.009). Administering fentanyl first required an average of 2.43 mg (29%) less midazolam (P < 0.001). No significant differences were found for change in vital signs, minimum oxygen saturation levels, recovery times, and patient satisfaction (P > 0.05). Oxygen saturation levels did not drop below 90% for either group; however, 5 cases in the fentanyl-first group fell to between 90% and 92%, compared with 0 cases in the midazolam-first group. Conclusions: The administration order of fentanyl and midazolam may have different effects on patients and the sedation procedure. Findings from this study should be used to facilitate discussion among dental practitioners and to guide additional research investigating this topic.
Conscious Sedation; Fentanyl; Midazolam; Moderate Sedation;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Ong CK, Seymour RA, Tan JM. Sedation with midazolam leads to reduced pain after dental surgery. Anesth Analg 2004; 98: 1289-93.
2 Moore PA, Finder RL, Jackson DL. Multidrug intravenous sedation: determinants of the sedative dose of midazolam.. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 84: 5-10.   DOI
3 Kelly A, Higgins P, Cunningham A, Hollingsworth J. Fentanyl Midazolam combination for endoscopy sedation is safe and effective. Gastroenterology 1998; 114: A22.
4 Mamula P, Markowitz JE, Neiswender K, Zimmerman A, Wood S, Garofolo M, et al. Safety of intravenous midazolam and fentanyl for pediatric GI endoscopy: prospective study of 1578 endoscopies. Gastrointest Endosc 2007; 65: 203-10.   DOI
5 The Alberta Dental Association and College. Standards for the use of sedation in non-hospital dental practice. Alberta; 2011.
6 Weaver JM. The narcotic or the benzodiazepine-which should be given first for IV conscious sedation? Anesth Prog 2001; 48: 123-4.
7 Absalon A, Struys M. An overview of TCI and TIVA. 2nd ed. Academia Press. 2007, 27-48.
8 Stander M, Wallis L. Procedural sedation in the emergency centre. S Afr Med J 2011; 101: 195-201.   DOI
9 The Dental Faculties of the Royal Colleges of Surgeons and the Royal College of Anaesthetists. Standards for conscious sedation in the provision of dental care. UK, 2015.
10 Academy of Medical Royal Colleges, Safe Sedation Practice for Healthcare Procedures: Standards and Guidance, 2013.
11 Dionne RA, Gift HC. Drugs used for parenteral sedation in dental practice. Anesth Prog 1988; 35: 199-205.
12 StataCorp. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP; 2015.
13 Edwards JA, Kinsella J, Shaw A, Evans S, Anderson KJ. Sedation for oocyte retrieval using target controlled infusion of propofol and incremental alfentanil delivered by non-anaesthetists. Anaesthesia 2010; 65: 453-61.   DOI
14 Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974; 2: 656-9.   DOI
15 van Dishoeck AM, van der Hooft T, Simoons ML, van der Ent M, Scholte op Reimer WJ. Reliable assessment of sedation level in routine clinical practice by adding an instruction to the Ramsay Scale. Eur J Cardiovasc Nurs 2009; 8: 125-8.   DOI
16 Mittal N, Goyal A, Jain K, Gauba K. Pediatric dental sedation research: Where do we stand today? J Clin Pediatr Dent 2015; 39: 284-91.   DOI
17 Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995; 7: 89-91.   DOI
18 Khader R, Oreadi D, Finkelman M, Jarmoc M, Chaudhary S, Schumann R, et al. A prospective randomized controlled trial of two different sedation sequences for third molar removal in adults. J Oral Maxillofac Surg 2015; 73: 224-31.   DOI
19 American Society of Anesthesiologists. Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia 2014 [Available from:].
20 Inverso G, Dodson TB, Gonzalez ML, Chuang SK. Complications of moderate sedation versus deep sedation/ general anesthesia for adolescent patients undergoing third molar extraction. J Oral Maxillofac Surg 2016; 74: 474-9.   DOI