• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.3
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• pp.412-420
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• 2004

The purpose of this study was to assess the anterograde amnesic effect of Midazolam administrated by intranasal and oral route. Fifteen healthy volunteers(ASA I) were administrated with placebo, oral Midazolam(15mg), intranasal Midazolam(0.25mg/kg) every 2 weeks. First picture cards were shown to volunteers before medication. At 15, 30, 45 minutes, other picture cards were shown to volunteers. BP, $SpO_2$ and sedation scores were measured. After 24 hours, the volunteers were questioned about their memory of pictures. To assess amnesic effect, recall and recognition test were performed using a series of picture cards designed for this purpose. The obtained results were as follows; 1. Compared to placebo, Midazolam group(oral and intranasal) experienced a significant anterograde amnesic effect(P<0.01) 2. There was no difference between oral and intranasal Midazolam(P>0.01). 3. Anterograde amnesic effect of oral and intranasal Midazolam group began at 15minutes. It became increasingly, oral Midazolam group experienced extremely amnesic effect at 45minutes, intranasal Midazolam group was at 30minutes. 4. After 30minutes of Midazolam administration, anterograde amnesia of oral Midazolam group is more effective than intranasal Midazolam group.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.2 no.2
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• pp.142-146
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• 2006

Oral administration of chloral hydrate with hydroxyzine, nitrous oxide inhalation and intramuscular or intranasal administration of midazolam is the most commonly used pharmacological behavior management methods for the children in pre-cooperative stage or show negative behavior in pediatric dentistry. For oral administration of chloral hydrate with hydroxyzine, it is hard to apply to the patient refused to intake and with overweighted or elderly children and the effect of the drug decrease. Nitrous oxide and midazolam is anxiolytic agents and have limitation for properly managing the behavior of the children refuse to dental treatment. These occasions, deep sedation or general anesthesia can be considered. Although intravenous sedation with midazolam has many advantages such as, rapid onset and recovery, possible to titration and few side effect, no rebound effect by metabolites, the reports for, intravenous sedation with midazolam is insufficient in pediatric dentistry. We report the case in pre-cooperative stage. He is treated successfully under intravenous sedation with midazolam.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.5
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• pp.408-412
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• 2010

Introduction: This study examined the depth of sedation and the usefulness of the monitoring tool in determining the level of sedation in patients undergoing third molars extraction under conscious sedation with midazolam. Materials and Methods: Twenty two patients undergoing third molars extraction at the department of Oral and Maxillofacial surgery, Ewha Womans Mokdong Hospital from February 2010 to April 2010 were analyzed. All patients were classified as American Society of Anesthesiologist (ASA) class I and had no contraindications tosedation. The bispectral index was recorded continually during surgery using a bispectral monitor. The initial sedation was accomplished using a 3 mg bolus of midazolam followed by a 2 mg bolus of midazolam until the level of sedation, at which the patient’s eyes were closed or the subject was responsive only to loud or repeated calling of their name, was reached. All subjects were surveyed with a postoperative questionnaire to evaluate the level of sedation. Results: The bispectral index (BIS) decreased approximately 5 minutes after midazolam administration, but increased at the local anesthesia injection and odontomy procedure. The amnestic effect was shown effectively in the early stages of surgery. Conclusion: Conscious sedation with intravenous midazolam is effective in achieving the effect of anxiolysis, analgesia and amnesia. The BIS is an objective and useful means of assessing the depth of sedation.

• Journal of The Korean Dental Society of Anesthesiology
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• v.9 no.2
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• pp.104-107
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• 2009

Midazolam, one of the most common benzodiazepine derivatives, is widely used in intravenous sedation for dental treatment without severe complications. However, paradoxical reactions to midazolam, including patient's unanticipated restlessness, agitation, hostility, and rage, have been frequently reported since the introduction of benzodiazepine. During outpatient intravenous sedation using midazolam for dental treatment, we experienced a paradoxical reaction to midazolam in a 28-year-old female patient. With a thorough review of the literature, the management of this complication and its various etiologies were discussed.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.2
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• pp.153-158
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• 2011

Midazolam is known to produce sedation as well as amnesia. Many articles reported about anterograde amnesia, but it is rare that articles about retrograde amnesia. The 61-year-old female patient (64 kg, 154 cm, ASA physical status I) was administered 3.02 mg (0.047 mg/kg) of midazolam during 2 hours. The patient's Modified Observer's Assesment of Alertness/Sedation Scale was 4. The patient who had been consciously sedated with midazolam, exhibited profound amnesia, both anterograde and retrograde after implantation. The patient's memory restoration was begun after 6 hours.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.2
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• pp.131-134
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• 2008

Purpose: The objective of this study was to evaluate the clinical parameters in terms of the midazolam sedation in patients undergoing dental practice. Patients and Methods: Total 28 patients were included in this study. They received the dental practice in the daycare center and sedation was done with midazolam. The recorded variables were blood pressure, pulse rate, $SpO_2$, and patient's response. The differences between observations were analyzed with paired samples t-test. Results: The blood pressure was significantly decreased after the administration of midazolam and the systolic pressure was significantly increased at the start of operation (P<0.05). The pulse rate was significantly increased after lidocaine injection (P<0.001). The amnesic effect was shown 21 cases out of 28 cases (75%). Conclusions: The effect of midazolam on pulse rate was not significant. However, midazolam could decrease the blood pressure significantly. Therefore, the sedation with midazolam could be successfully used in the dental practice, particularly for the patients having the hypertension.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.1
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• pp.53-61
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• 2006

When routine behavior control is impossible, midazolam is often used for sedation, because it has wide margin of safety, relatively few side-effects and multiple route of administration. Although intramuscular administration of all administration route is frequently used, it is a major source of anxiety, discomfort, and trauma in children. To the contrary, oral administration of midazolam is easily administered and accepted by children. But, it's therapeutic drug concentration has not been established. The purpose of this study was to compare sedation effect and physiologic parameter of oral midazolam which palliate demerits of intramuscular administration in sedating young pediatric patients with intramuscular midazolam Twelve negative children, mean age 62.5 months, who needed at least two separate restorative visits, requiring local anesthesia participated in this study On every visit, one of the following 2 different sedative regimen was given : (1) 0.30mg/kg midazolam by intramuscular administration (2) 0.75mg/kg by oral administration. Physiologic parameter(oxygen saturation, heart rate) was recorded by ten procedure and behavior was videotaped and rated using Ohio State University Behavior Rating Scale and Automated Counting System by one investigator, blind to administration route The analyzed sedative effect of oral midazolam resulted in good sedative effect, comparing to intramuscular route, And there is no statistically difference between oral and intramuscular administration of midazolam (p>0.05).

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.2
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• pp.113-117
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• 2008

Background: The purpose of this study was to compare the use of midazolam only with midazolam with fentanyl or propofol in IV sedation. Methods: 24 cases were divided to midazolam group (M group), midazolam + fentanyl group (MF group), midazolam + propofol group (MP group) and midazolam + fentanyl + propofol group (MFP group). In M group, 2 ml midazolam was injected at first, than at 2 minutes interval 1-2 ml injected continuously depending on the level of sedation. In MP, MFP groups, propofol was injected at the speed of 15-20 ml/hr by infusion pump. In this study, the sedation level was evaluated by using OAA/S scale. In each groups, the recovery time was measured until OAA/S scale score level was 5, and pre and postoperative blood pressure change was measured. Each group's data was statistically analyzed using one-way ANOVA. If significant statistical difference were observed, Dunnet test was performed, and control group was M group. Results: Pre and postoperative blood pressure change were not represent significant statistical difference in 4 groups (P value = 0.679 [systolic], P value = 0.206 [diastolic]). But recovery time were represent significant statistical difference (M group: 35.6, MF group: 32.5, MP group: 17.9, MFP group: 19.6 [P value = 0.002]). The result of Dunnet test on recovery time showed significant statistical difference on MF, MFP group when M group was control group. In MFP group, sedation was increased by using supplemental fentanyl, and postoperative pain control was dominant. Conclusion: To achieve the effect of anxiolysis, analgesia, amnesia effectively, and short recovery time, MFP group is mostly recommended.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.2
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• pp.69-74
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• 2012

Background: The purpose of this study is to investigate the efficacy and safety of the sedation technique for implant surgery by combining the use of inhalation of nitrous oxide/oxygen with intravenous midazolam. Methods: Patients requiring surgery for the placement of dental implants were randomly allocated to two groups receiving intravenous midazolam or a combined technique using nitrous oxide/oxide and intravenous midazolam. Safety parameters, cooperation scores, anxiety scales, total amount of midazolam administered and recovery time were recorded and compared. Results: There were a statistically significant reduction in the amount of midazolam required to achieve optimal sedation (P<0.01), an overall significant reduction in recovery time (P<0.01), a significant reduction in anxiety scales (P<0.05), and a significant improvement in cooperation (P<0.05) and peripheral oxygen saturation (P<0.05) when a combined technique of inhalational $N_2O/O_2$ and midazolam was used. Conclusions: For implant surgery, this combining sedation technique could be safe and reliable, demonstrating reduction of total dose of midazolam and level of patient's anxiety and improvement in patient's recovery and cooperation.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.4
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• pp.223-227
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• 2012

Autism patients in general have bad oral hygiene. It is hard for autism patients to get dental treatment as poor communication. Therefore, they may have to be treated by deep sedation or general anesthesia in numerous cases. However, this process requires induction with mask, so it is not easy to do for disobliging autism patient. Midazolam is a water-soluble benzodiazepine, has been used in pediatric dentistry or dentistry for the handicapped because of rapid onset. Midazolam can be administered through oral, rectal, intramuscular,intravenous, and intranasal (IN) routes. IN route of midazolam may be considered as effective way to allay for uncooperative autism patients before general anesthesia. In this case report, two autism patients required dental treatment. Intranasal spray of midazolam before general anesthesia was safe and effective procedure of behavioral management.