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Comparative evaluation of psychological effects of four intravenous conscious sedation techniques during dental implant surgery
Naser Kaviani,Azizollah Norouzi
Journal of Isfahan Dental School , 2012,
Abstract: Introduction: Intravenous conscious sedation is widely used to control anxiety and increase patient tolerance during implant surgeries. Patients experience various sensations due to the use of different medications. In this study, patients’ sensations during conscious sedation were evaluated with the use of four IV sedation regimes to determine the best protocol. Materials and Methods: In this double-blind randomized clinical trial, 112 patients who were candidates for dental implants were evaluated in four groups: Midazolam, Midazolam/Fentanyl, Midazolam/Acetaminophen and Midazolam/Ketamine. At the end of recovery they were asked about their sensations during surgery. Data were analyzed with Pearson’s, chi-squared, Mann-Whitney and Kruskal-Wallis tests and ANOVA (α = 0.05).Results: Pearson’s and chi-squared tests did not reveal any significant differences between the groups in relation to age, sex, and educational status; ANOVA did not show any differences between the groups in relation to duration of recovery and surgery and the dose of Midazolam used. Kruskal-Wallis test revealed significant differences in pleasant feelings between the four groups (p value < 0.001); Mann-Whitney test did not show any significant differences in pleasant sensations between the Midazolam and Midazolam/Ketamine groups (p value = 0.084). However, frequency of pleasant sensation was significantly higher in the Midazolam/Fentanyl group compared to that in the Midazolam group (p value = 0.008). Frequency of pleasant sensation was significantly higher in the Midazolam/Acetaminophen group compared to that in the Midazolam/Ketamine group (p value = 0.001). Kruskal-Wallis did not reveal any significant differences in pleasant sensations between the four groups (p value = 0.211). Conclusion: Based on the results of the present study, combined use of analgesics and sedatives gives rise to good sensations in patients during surgery and increases sedation efficacy and patient cooperation and satisfaction with the sedation procedure. Key words: Conscious sedation, Dental implants, Psychological
Conscious sedation-An artist′s science! An Indian experience with midazolam  [cached]
Shashikiran N,Reddy Subba,Yavagal C
Journal of the Indian Society of Pedodontics and Preventive Dentistry , 2006,
Abstract: The present study was undertaken to evaluate Midazolam as a Paediatric conscious sedative agent for a routine Indian dental setup and to compare its efficacy and safety when administered by intranasal and intramuscular routes, at a dosage of 0.2 mg/kg body weight. The present study was accomplished in two phases: Phase 1: Preliminary dose finding pilot study on 10 children. Phase 2: Single dose, randomized parallel clinical trial on 40 children between the ages of 2 and 5 years. These children were randomly assigned to two groups consisting of 20 subjects each. Group M, received Midazolam intramuscularly, while Group N received Midazolam intranasally. Both the intranasal and intramuscular groups showed highly significant decrease in crying levels, motor movements and sensory perception levels, post-sedation ( P < 0.001). Though both the routes almost matched each other in their efficacy and safety profiles, the intranasal route showed a significantly faster pharmacodynamic profile in terms of faster onset, peak and recovery times ( P < 0.001). Midazolam could be safely and successfully employed by intranasal and intramuscular routes for Paediatric conscious sedation in a routine dental setup with basic facilities at a dosage of 0.2 mg/ kg body weight. Whenever the clinical situation warrants a faster action, peak and recovery, the intranasal route should be the obvious choice.
Assessment of a low dose of IV midazolam used orally for conscious sedation in pediatric dentistry
M Mortazavi,SJ. Pourhashemi,M.B. Khosravi,S Ashtari
DARU : Journal of Pharmaceutical Sciences , 2009,
Abstract: Background and the purpose of the study: Midazolam is preferably used in pediatric dentistry for quick onset of action and recovery. The aim of this prospective, observer-blind and placebo-controlled study was to assess the efficacy of a low dose of oral midazolam in modification of the behavior of young pediatric dental patients. Methods: Forty children aged 3 to 5 years who displayed ratings 1 or 2 on the Frankl Scale and were healthy by the American Society of Anesthesiologists-I status were randomly divided into two experimental and control groups of 20 each. All children required pulpotomy and restoration of D and E teeth and received either 0.25mg/kg of a 15mg/3ml IV midazolam mixed in black cherry syrup or the syrup alone. Subjects were continuously observed and monitored with pulse oximetry. Houpt's Behavioral Ratings was used to determine the overall behavior, the degree of crying and movement during treatment. Mann-Whitney U test was used for statistical analysis. Results and major conclusion: Patients who received 0.25mg/kg of the prepared oral midazolam significantly behaved better during treatment than the placebo controls (P<0.05). In comparison with the placebo group, reduced movement and crying were observed in the midazolam group (P<0.05). No adverse effects were observed and treatments were completed successfully. A low dose of 0.25mg/kg of a 15mg/3ml IV midazolam mixed in black cherry syrup was found to be effective in conscious sedation of young pediatric dental patients.
Conscious Sedation for Endoscopic Retrograde Cholangiopancreatography: Dexmedetomidine Versus Midazolam  [cached]
Neslihan Kilic,Sukran Sahin,Hale Aksu,Belgin Yavascaoglu
Eurasian Journal of Medicine , 2011,
Abstract: Objective: Midazolam and dexmedetomidine, which are used for sedation during endoscopic retrograde cholangiopancreatography, were compared to evaluate the differences in efficacy, hemodynamics, and side effects. Materials and Methods: Fifty patients aged between 18 and 80 were randomly assigned to two groups according to American Society of Anesthesiologists (ASA) classification: Group M received midazolam with an initial bolus infusion of 0.04 mg/kg intravenously (i.v.), followed by additional doses of 0.5 mg i.v. midazolam, titrated to achieve a Ramsay sedation scale score of 3-4. Group D received dexmedetomidine with an initial bolus infusion of 1 mcg/kg/hr i.v. over 10 minutes, followed by a continuous infusion of 0.2-0.7 mcg/kg/hr, titrated to achieve an RSS of 3-4. A Mini Mental Status Examination (MMSE) was performed prior to sedation and in the recovery room once the Modified Aldrete Score (MAS) reached 9-10. Patient heart rates, arterial pressure and pain were evaluated. Results: Patients in Group D had lower heart rates at 20, 25, 30, 35 and 40 minutes following the initiation of sedation (p<0.05). There was no statistical difference in arterial pressure, RSS, MMSE or respiratory rate between the two groups. Coughing, nausea and vomiting occurred in 3 patients in Group M (12%), whereas no patient in Group D experienced these symptoms. The procedure elicited a gag response in 7 patients in Group M (28%) and in 4 patients in Group D (16%), with no significant difference between groups (p>0.05). When patient and surgeon satisfaction was compared between the two groups, Group D showed higher surgeon satisfaction scores (p<0.05). Conclusion: The use of dexmedetomidine for conscious sedation during short, invasive procedures, such as endoscopic retrograde cholangiopancreatography, could be a superior alternative to the use of midazolam.
Superiority of split dose midazolam as conscious sedation for outpatient colonoscopy  [cached]
Hyuk Lee, Jeong Hwan Kim
World Journal of Gastroenterology , 2009,
Abstract: AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy.METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A (n = 40) received a split dose of midazolam in combination with meperidine. Group B (n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events.RESULTS: Group A had a lower frequency of significant hypoxemia (P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B (P = 0.043). Group B recovered from sedation slightly sooner than group A (P < 0.002). Scores for pain and memory, except insertion-related memory, were lower in group A one week after colonoscopic examination (P = 0.018 and P < 0.030, respectively). Poor patient controllability was noted by the endoscopist and nurse in group B (P = 0.038 and P = 0.032, respectively).CONCLUSION: Split dose midazolam in combination with meperidine resulted in a safer, more equable sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.
Comparative Evaluation of Sedative Effects of Oral Midazolam and Oral Ketamine in Combination with Inhalation Sedation for Pediatric Behavior Control during Dental Treatment
N Kaviani,A Eshghi,P Tabibian
Journal of Isfahan Dental School , 2007,
Abstract: Introduction: Oral route for conscious sedation is very easy to administer drugs and has good acceptance. Oral Midazolam and Ketamine provide the effective sedation. Also conscious sedation with combination techniques increases efficacy. N2O/O2 can be combined with other routes for conscious sedation. In this study the effectiveness of oral midazola-N2O and oral ketamine-N2O in behavioral management of children uncooperative during dental treatment was evaluated.Methods and Materials: In this study we randomly divided 60 healthy, uncooperative children of 3-7 years old in two groups. One group was administered Midazolam 0/5 mg/kg and another was administered Ketamine 6 mg/kg. After 15 minute N2O/O2 with 50%: 50% administrated. Scores of crying, consciousness, movement and general behavior are evaluated during dental procedure base on Houpt rating scale. Data were analyses with SPSS software.Results: In both groups efficacy of sedation was more than 90% and there were not statistically significant difference between two groups. In Midazolam group, consciousness during dental procedure was higher and recovery time was shorter.Conclusion: Results indicated that positive and good effect of oral Midazolam or Ketamine with nitrous oxide for sedation and control of movement in children during dental treatment. Because the easy of usage and low side effects we can use form this methods for children behavior control during dental procedures.Key words: Pediatric dentistry, Conscious sedation, Midazolam, Ketamine, N2O
Analgo-sedación consciente con midazolam y fentanilo oral transmucosa (OTFC) en ni os Conscious analgo-sedation with midazolam and fentanyl (OTFC) in children  [cached]
L. C. álvarez-López,J. González de Zárate,E. Herrero,M. Páez
Revista de la Sociedad Espa?ola del Dolor , 2006,
Abstract: Con elevada frecuencia, a los ni os afectos de leucemias y otras enfermedades neoplásicas se les deben realizar una serie de pruebas diagnósticas y de tratamientos (punciones de médula ósea, administración intratecal de medicamentos…) que producen dolor y que aumentan considerablemente el disconfort y sufrimiento o impiden la realización de las técnicas. La realización de técnicas de sedación consciente con fármacos utilizados por vía oral como el fentanilo (Citrato de Fentanilo Oral Transmucosa -OTFC-) junto con midazolam, y el empleo de anestésico local en el lugar de punción, puede hacer que estas técnicas dolorosas sean bien toleradas por parte del paciente, evitando así el dolor y disminuyendo la angustia, el miedo y sufrimiento que representa para los ni os la realización de cualquier prueba o tratamiento. Multiple bone marrow aspirations and lumbar punctures are performed on children with leukaemia and other neo-plastic disorders during the course of their illnesses. These procedures may give rise to considerable pain and distress in children. Fentanyl, a short-acting potent synthetic opioid, can produce sedation through oral transmucosal (Oral Transmucosal Fentanyl Citrate -OTFC-) administration. The combination of OTFC and oral midazolam was a useful conscious sedation technique for painful procedures, such as lumbar punctures and bone marrow aspirations in this patients.
Intravenous sedation with midazolam and propofol target controlled infusion on patients’ perioperative anxiety under the mandibular third molar extraction

- , 2017, DOI: 10.3969/j.issn.1671-167X.2017.06.019
Abstract: 关键词: 清醒镇静, 麻醉, 静脉, 焦虑, 磨牙, 第三, 拔牙
Key words: Conscious sedation, Anesthesia, intravenous, Anxiety, Molar, third, Tooth extraction
Assessment of Intranasal Midazolam Administration with a Dose of 0.5mg/kg in Behavioral Management of Uncooperative Children
A - Eshghi,N Kavyani,R Mazaheri
Journal of Isfahan Dental School , 2005,
Abstract: Introduction. Some children show aggressive uncontrollable behavior during dental procedures, the only way to control this behavior is pharmacological methods such as conscious sedation. Recently intranasal administration of midazolam has been considered. The main goal of our study is to determine the effectiveness of intranasal administration of midazolam (in a does of 0.5 mg/kg) in behavioral management of uncooperative children.Methods and Materials. In this study 30 healthy, uncooperative children of 3 to 5 years old were evaluated. At the beginning of each session, we tried to use ordinary techniques of behavioral management in treatment of patients. In the case of unsatisfactory response intranasal midazolam was immediately used. To determine the affectivity of the drug, evaluation of child behavior before and after administration of midazolam was undertaken, using Houpt rating scale of general behavior.Results. A statistically significant difference was demonstrated in patients behavior before and after administration of intranasal midazolam (based on Houpt rating scale of general behavior). Thus we concluded that this drug is effective in sedation and reducing the anxiety of children under treatment.Discussion. Although the results are indicative of a positive effect of drug in sedating patients, this is not indicating that a child with a behavioral score of 1 or 2 of Houpt scale will be changed to a child with scores of 5 or 6 after administration of the drug. In fact this drug makes children more controllable in comparison to their previous condition and reduces their range of movement and crying so that dentist will be able to work in a relatively more suitable condition. Midazolam has the most effect in children who have a greater potential to cooperate and have a mild to moderate degree of anxiety.Key words. Intranasal midazolam, Pediatric dentistry, Conscious sedation.
Evaluation of single-stage adjustable strabismus surgery under conscious sedation  [cached]
Sharma Pradeep,Julka Anurag,Gadia Ritu,Chhabra Anjolie
Indian Journal of Ophthalmology , 2009,
Abstract: Purpose: To evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS) performed under topical anesthesia. Materials and Methods: Forty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients′ experience of the surgery (by questionnaire) were also compared. Results: Mean preoperative deviation for distance in Groups I, II, III was -41.67 prism diopter (pd) ±9.0, -38.93 pd ±11.05 and -41.87 pd ±8.91 ( P =0.6) respectively. At three months, mean correction achieved for distance was +31.87 pd ±11.71, +35.47 pd ±10.86 and +42.80 pd ±10.71 respectively which was significantly different between Group III and Group I ( P =0.03). Intraoperatively all hemodynamic parameters remained stable and comparable ( P =0. 5) in all groups. Intraoperative pain ( P < 0.001) and time taken for surgery ( P < 0.001) was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups ( P = 0.5). Conclusions: SSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.
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