Browse > Article
http://dx.doi.org/10.17245/jdapm.2018.18.4.245

Analysis of the effect of oral midazolam and triazolam premedication before general anesthesia in patients with disabilities with difficulty in cooperation  

Lim, Seon Woo (Department of Dental Anesthesiology, Seoul National University, School of Dentistry)
So, Eunsun (Department of Dental Anesthesiology, Seoul National University Dental Hospital)
Yun, Hye Joo (Department of Dental Anesthesiology, Seoul National University Dental Hospital)
Karm, Myong-Hwan (Department of Dental Anesthesiology, Seoul National University Dental Hospital)
Chang, Juhea (Special Care Clinic, Seoul National University Dental Hospital)
Lee, Hanbin (Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital)
Kim, Hyun Jeong (Department of Dental Anesthesiology, Seoul National University, School of Dentistry)
Seo, Kwang-Suk (Department of Dental Anesthesiology, Seoul National University, School of Dentistry)
Publication Information
Journal of Dental Anesthesia and Pain Medicine / v.18, no.4, 2018 , pp. 245-254 More about this Journal
Abstract
Background: When performing dental treatment under general anesthesia in adult patients who have difficulty cooperating due to intellectual disabilities, anesthesia induction may be difficult as well. In particular, patients who refuse to come into the dental office or sit in the dental chair may have to be forced to do so. However, for adult patients with a large physique, physical restraint may be difficult, while oral sedatives as premedication may be helpful. Here, a retrospective analysis was performed to investigate the effect of oral sedatives. Methods: A hospital-based medical information database was searched for patients who were prescribed oral midazolam or triazolam between January 2009 and December 2017. Pre-anesthesia evaluation, anesthesia, and anesthesia recovery records of all patients were analyzed, and information on disability type, reason for prescribing oral sedatives, prescribed medication and dose, cooperation level during anesthesia induction, anesthesia duration, length of recovery room stay, and complications was retrieved. Results: A total of 97 patients were identified, of whom 50 and 47 received midazolam and triazolam, respectively. The major types of disability were intellectual disabilities, autism, Down syndrome, blindness, cerebral palsy, and epilepsy. Analyses of changes in cooperation levels after drug administration showed that anesthesia induction without physical restraint was possible in 56.0% of patients in the midazolam group and in 46.8% of patients in the triazolam group (P = 0.312). Conclusions: With administration of oral midazolam or triazolam, general anesthesia induction without any physical restraint was possible in approximately 50% of patients, with no difference between the drugs.
Keywords
Dental Treatment; General Anesthesia; Intellectual Disability; Midazolam; Sedative Premedication; Triazolam;
Citations & Related Records
Times Cited By KSCI : 3  (Citation Analysis)
연도 인용수 순위
1 Mitchell A, Clegg J. Is post-traumatic stress disorder a helpful concept for adults with intellectual disability? J Intellect Disabil Res 2005; 49: 552-9.   DOI
2 Luiselli JK, Pace GM, Dunn EK. Antecedent analysis of therapeutic restraint in children and adolescents with acquired brain injury: A descriptive study of four cases. Brain Inj 2003; 17: 255-64.   DOI
3 Holm-Knudsen RJ, Carlin JB, McKenzie IM. Distress at induction of anaesthesia in children. A survey of incidence, associated factors and recovery characteristics. Paediatr Anaesth 1998; 8: 383-92.   DOI
4 Tripi PA, Palermo TM, Thomas S, Goldfinger MM, Florentino-Pineda I. Assessment of risk factors for emergence distress and postoperative behavioural changes in children following general anaesthesia. Paediatr Anaesth 2004; 14: 235-40.   DOI
5 Bozkurt P. Premedication of the pediatric patient - anesthesia for the uncooperative child. Curr Opin Anaesthesiol 2007; 20: 211-5.   DOI
6 Cote CJ, Cohen IT, Suresh S, Rabb M, Rose JB, Weldon BC, et al. Acomparison of three doses of a commercially prepared oral midazolam syrup in children. Anesth Analg 2002; 94: 37-43.   DOI
7 Levine MF, Spahr-Schopfer IA, Hartley E, Lerman J, MacPherson B. Oral midazolam premedication in children: The minimum time interval for separation from parents. Can J Anaesth 1993; 40: 726-9.   DOI
8 Stopperich PS, Moore PA, Finder RL, McGirl BE, Weyant RJ. Oral triazolam pretreatment for intravenous sedation. Anesth Prog 1993; 40: 117-21.
9 Peretz B, Gluck GM. The use of restraint in the treatment of paediatric dental patients: Old and new insights. Int J Paediatr Dent 2002; 12: 392-7.   DOI
10 Kinirons MT, Lang CC, He HB, Ghebreselasie K, Shay S, Robin DW, et al. Triazolam pharmacokinetics and pharmacodynamics in caucasians and southern asians: Ethnicity and cyp3a activity. Br J Clin Pharmacol 1996; 41: 69-72.   DOI
11 Pickrell JE, Hosaka K, Jackson DL, Heima M, Kharasch E, Milgrom PM. Expanded studies of the pharmacokinetics and clinical effects of multidose sublingual triazolam in healthy volunteers. J Clin Psychopharmacol 2009; 29: 426-31.   DOI
12 Christiansen E, Chambers N. Induction of anesthesia in a combative child; management and issues. Paediatr Anaesth 2005; 15: 421-5.   DOI
13 Lim M, Borromeo GL. The use of general anesthesia to facilitate dental treatment in adult patients with special needs. J Dent Anesth Pain Med 2017; 17: 91-103.   DOI
14 Haywood PT, Karalliedde LD. General anesthesia for disabled patients in dental practice. Anesth Prog 1998; 45: 134-8.
15 Seo KS, Shin TJ, Kim HJ, Han HJ, Han JH, Kim HJ, et al. Clinico-statistical analysis of cooperation and anesthetic induction method of dental patients with special needs. J Korean Dent Soc Anesthesiol 2009; 9: 9-16.   DOI
16 American Dental Association. Guidelines for the use of sedation and general anesthesia by dentists 2007.
17 Koh GH, Kim SH, Son HJ, Jo JY, Choi SS, Park SU, et al. Pulmonary aspiration during intubation in a high-risk patient: A video clip and clinical implications. J Dent Anesth Pain Med 2018; 18: 111-4.   DOI
18 Hanamoto H, Boku A, Sugimura M, Oyamaguchi A, Inoue M, Niwa H. Premedication with midazolam in intellectually disabled dental patients: Intramuscular or oral administration? A retrospective study. Med Oral Patol Oral Cir Bucal 2016; 21: e470-6.
19 Horacek J, Palenicek T, Malek J, Scigel V, Kurzova A, Hess L. The influence of clonidine on oral ketaminemidazolam premedication in intellectually disabled patients indicated for dental procedures: Double-blind comparison of two sedation regimes. Neuro Endocrinol Lett 2012; 33: 380-4.
20 Lee Y, Kim J, Kim S, Kim J. Intranasal administration of dexmedetomidine (dex) as a premedication for pediatric patients undergoing general anesthesia for dental treatment. J Dent Anesth Pain Med 2016; 16: 25-9.   DOI
21 Son YG, Shin J, Ryu HG. Pneumonitis and pneumonia after aspiration. J Dent Anesth Pain Med 2017; 17: 1-12.   DOI
22 Higgins M. Dental anesthesiology--an access to care issue. Alpha Omegan 2006; 99: 56-63.   DOI
23 Boyle CA, Manley MC, Fleming GJ. Oral midazolam for adults with learning disabilities. Dent Update 2000; 27: 190-2.   DOI
24 Lee BS, Seo KS, Shin TJ, Kim HJ, Han HJ, Chang J. Premedication of oral midazolam for smooth anesthesia induction of uncooperative patients. J Korean Dent Soc Anesthesiol 2011; 11: 125-32.   DOI
25 Lieblich SE, Horswell B. Attenuation of anxiety in ambulatory oral surgery patients with oral triazolam. J Oral Maxillofac Surg 1991; 49: 792-6.   DOI
26 Solomon A. Indications for dental anesthesia. Dent Clin North Am 1987; 31: 75-80.