Resident: Matthew Freitas
Author(s): Kil et al.Journal: Pediatric Dentistry; 2003. 25. 137-142.
-To examine the safety and efficacy of midazolam in asthmatic pediatric patients undergoing dental treatment.
Methods:-24 children, 17 males and 7 females were selected for this study.
-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.
-NPO 4 hours prior to tx-A preoperative assessment: 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. And then again at the end of the dental treatment.At the end of the dental treatment, asthma score, pulse rate, and respiratory rates were recorded.
-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.
-Oxygen saturations remained normal and consistently above 95% throughout the entire procedure for all but 2 patients.
-2 children had oxygen saturations that fell down to 94% at some point during treatment, however, O2 sat increased after their heads were tilted back to open the airway.
-Asthma scores remained the same.
-Oxygen saturation and respiratory rates stayed relatively constant throughout treatment.
-The pulse rate rose continuously from 5 minutes through 15 minutes; local anesthetic injection and initiation of treatment likely the cause of increased pulse.
-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.
-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.
-Most patients were treated with minimal difficulty.
-Midazolam is a safe and effective means of sedation for patients with mild to moderate asthma.