Effects of Midazolam on asthmatic children

Resident: Cho

Author(s): Kil et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2003. 25. 137-142.

Major topic: Oral Sedation, Asthma, Midazolam

Type of Article: Scientific Article

Main Purpose: To examine the safety and efficacy of midazolam in asthmatic pediatric patients undergoing dental treatment.

Overview of method of research:

24 children, 17 males and 7 females were selected for this study. The inclusion criteria included: children aged 1-6 years old with a diagnosis of mild-intermittent, mild-persistent, or moderate-persistent asthma in need of routine restorative work or extractions with sedation for behavior management. Subjects presented without food or fluids ingestion 4 hours prior to dental treatment.

A preoperative assessment included a modified asthma score, respiratory rate, pulse rate, and oxygen saturation. Each child was given 0.5mg/kg of midazolam orally. After 10 minutes, the child was separated from the parents and pulse oximeter monitor was affixed to the patient. Respiratory rate, pulse rate, and oxygen saturation were all monitored in 5 minute intervals throughout dental treatment. If necessary, a papoose board was used to control disruptive harmful behaviors. At the end of the dental treatment, asthma score, pulse rate, and respiratory rates were recorded. Immediately after the treatment, the dental operator assessed the sedation outcome using a behavior assessment. Oxygen saturation, pulse rate, and respiratory rates were also recorded 30 minutes after treatment.

Findings:

For all subjects except 2, oxygen saturations remained normal and consistently above 95% throughout the entire procedure. The 2 subjects had oxygen saturations that fell down to 94% at some point during treatment, however, oxygen saturation increased when the patient’s head and neck were repositioned.

All subjects had the same asthma score before and after treatment. Oxygen saturation and respiratory rates stayed relatively constant throughout treatment. The pulse rate rose continuously from 5 minutes through 15 minutes – this was not clinically significant since local anesthetic injection and initiation of treatment would increase pulse rate.

12 subjects had excellent behavior, 5 subjects had satisfactory behavior, and 7 subjects had unsatisfactory behavior. 5 patients required the use of the papoose board due to uncooperative behavior.

Key points/Summary:

1. Sedation with midazolam, when given orally at a dose of 0.5mg/kg, produces little to no adverse effects on asthmatic patients presenting with mild to moderate symptoms.

2. Most patients were treated with minimal difficulty at a dosage of 0.5mg/kg of midazolam.

3. With strict adherence to the AAPD sedation guidelines, midazolam is a safe and effective means of sedation for patients with mild to moderate asthma.

Assessment of Article: Interesting study – a greater sample size would have strengthened the study.