Behavioural and Physiological Effects of Oral Midazolam Premedication in Paediatric Dental General Anaesthesia: A Pilot Study
Pharmaceutical Science-Oral Midazolam
DOI:
https://doi.org/10.22376/ijlpr.2023.13.4.P95-P104Keywords:
behavior/behavior, general dental anesthesia, oral Midazolam, premedication.Abstract
Children undergoing anesthesia, including dental treatment under general anesthesia (DGA), tend to develop severe preoperative anxiety. Oral Midazolam is one of the many premedications used in controlling behavior and reducing anxiety in children before general anesthesia. This study is aimed to evaluate the effect of oral midazolam premedication on recovery behavior and physiologic effects of children undergoing DGA. It involved thirty uncooperative children aged from 2 to 11 years old. Group I (n = 15): children received 0.5 mg/kg midazolam orally, while Group II (n = 15): children who did not receive any premedication. Their peripheral capillary oxygen saturation, respiratory rate, and heart rate were measured upon arrival at the post-anesthesia care unit. The recovery behavior was evaluated using the Modified Houpt Behavior Rating Scale. Fisher's Exact test and Mann-Whitney test were used for data analysis. There are no significant differences in both groups' post-behavior and physiologic parameters (p>0.05). However, children in Group II reported tachycardia (13.3%, n= 2), hypoxemia (13.3%, n= 2), and bradypnea (13.3%, n= 2), compared to one case of bradypnea (6.7%) in Group I at 30 minutes. Although there were no significant differences between both groups (p>0.05), Group I showed less movement and no crying reaction but was more awake—no significant association of premedication oral midazolam with successful recovery behavior (p=0.381). One child in Group II had an episode of vomiting. An interesting pattern of improved recovery behavior and physiology was identified among children receiving oral midazolam premedication. More research with a bigger sample size is needed to investigate the effect of oral Midazolam in pediatric DGA and to determine the optimal effect of premedication.
References
Klingberg G. Dental anxiety and behavior management problems in pediatric dentistry—a background factors and diagnostics review. Eur Arch Paediatr Dent. 2008 Feb;9;Suppl 1:11-5. doi: 10.1007/BF03262650, PMID 18328243.
Ramos-Jorge ML, Marques LS, Pavia SM, Serra-Negra JM, Pordeus IA. Predictive factors for child behavior in the dental environment. Eur Arch Paediatr Dent. 2006 Dec 1;7(4):253-7. doi: 10.1007/BF03262561, PMID 17164071.
McNeil DW, Helfer AJ, Weaver BD, Graves RW, Kyle BN, Davis AM. The memory of pain and anxiety associated with tooth extraction. J Dent Res. 2011 Feb;90(2):220-4. doi: 10.1177/0022034510385689, PMID 21149859.
Esa R, Jamaludin M, Yusof ZYM. Impact of maternal and child dental anxiety on oral health-related quality of life of 5-6-year-old preschool children. Health Qual Life Outcomes. 2020 Dec;18(1):319. doi: 10.1186/s12955-020-01565-z, PMID 32993663.
Lee CY, Chang YY, Huang ST. Prevalence of dental anxiety among 5‐ to 8‐year‐old Taiwanese children. J Public Health Dent. 2007 Jan;67(1):36-41. doi: 10.1111/j.1752-7325.2007.00006.x, PMID 17436977.
Kilinç G, Akay A, Eden E, Sevinç N, Ellidokuz H. Evaluation of children's dental anxiety levels at a kindergarten and a dental clinic. Braz Oral Res. 2016 Aug 18;30(1). doi 10.1590/1807-3107BOR-2016.vol30.0072, PMID 27556551.
Savanheimo N, Sundberg SA, Virtanen JI, Vehkalahti MM. Dental care and treatments are provided under general anesthesia in the Helsinki Public Dental Service. BMC Oral Health. 2012 Dec;12(1):45. doi: 10.1186/1472-6831-12-45, PMID 23102205.
Samsudin NA, Ahmad W. WMA, Nashir MNM. Awang Nawi MA, Ibrahim MSM, Aleng, NA, Ghazali FMM, Akbar NAN, Noor NFM, Ghazali PL, Rahman NA. The common dental diagnosis under general anesthesia in Hospital Universiti Sains Malaysia: A four years pediatric case study. Sapporo Medical Journal. 2021 55 (2). 1-9.
Phaltankar J, Shah M. Oral midazolam as a pre-medication in pediatric patients. MVP J Med Sci. 2017 May 1;4(1):30-54. doi: 10.18311/mvpjms/0/v0/i0/12464.
Gregory DF, Koestner JA, Tobias JD. Stability of Midazolam prepared for oral administration. South Med J. 1993 Jul 1;86(7):771-2. doi: 10.1097/00007611-199307000-00010, PMID 8322084.
Bong CL, Ng AS. Evaluation of emergence delirium in Asian children using the Pediatric Anesthesia Emergence Delirium Scale. Paediatr Anaesth. 2009 Jun;19(6):593-600. doi: 10.1111/j.1460-9592.2009.03024.x, PMID 19645978.
Chorney JM, Tan ET, Martin SR, Fortier MA, Kain ZN. Children's behavior in the postanesthesia care unit: the development of child behavior coding system-PACU (CBCS-P). J Pediatr Psychol. 2012 Apr 1;37(3):338-47. doi: 10.1093/jpepsy/jsr101, PMID 22167123.
Cantekin K, Yildirim MD, Delikan E, Çetin S. Postoperative discomfort of dental rehabilitation under general anesthesia. Pak J Med Sci. 2014 Jul;30(4):784-8. doi: 10.12669/pjms.304.4807, PMID 25097517.
Coté CJ, Wilson S, American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for monitoring and managing pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics. 2019 Jun 1;143(6). doi 10.1542/peds.2019-1000, PMID 31138666.
Ahmad WM, Samsudin NA, Adnan MM, Husein A. Sample size calculations (study design based) using PS software and sampling selection (penerbit USM). Penerbit USM; 2019 Aug 9.
Tyagi P, Tyagi S, Jain A. Sedative effects of oral Midazolam, intravenous Midazolam, and oral diazepam in the dental treatment of children. J Clin Pediatr Dent. 2013 Apr 1;37(3):301-5. doi 10.17796/jpg.37.3.6u482603r0388558, PMID 23855176.
Buchanan H, Niven N. Validation of a Facial Image Scale to assess child dental anxiety. Int J Paediatr Dent. 2002 Jan;12(1):47-52. doi: 10.1046/j.0960-7439.2001.00322.x, PMID 11853248.
Houpt MI, Weiss NJ, Koenigsberg SR, Desjardins PJ. Comparison of chloral hydrates with and without promethazine in the sedation of young children. Pediatr Dent. 1985;7(1):41-6. PMID 3857559.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar 1;33(1):159-74. doi: 10.2307/2529310, PMID 843571.
Knapp R, Gilchrist F, Rodd HD, Marshman Z. Change in children’s oral health‐related quality of life following dental treatment under general anesthesia for managing dental caries: a systematic review. Int J Paediatr Dent. 2017 Jul;27(4):302-12. doi 10.1111/ipd.12259, PMID 27531644.
Keles S, Kocaturk O. Comparison of oral dexmedetomidine and Midazolam for premedication and emergence delirium in children after dental procedures under general anesthesia: a retrospective study. Drug Des Devel Ther. 2018 Mar 28;12:647-53. doi: 10.2147/DDDT.S163828, PMID 29636599.
Dave NM. Premedication and induction of anesthesia in pediatric patients. Indian J Anaesth. 2019 Sep;63(9):713-20. doi: 10.4103/ija.IJA_491_19, PMID 31571684.
Sheta SA, AlSarheed M. Oral midazolam premedication for children undergoing general anesthesia for dental care. Int J Pediatr. 2009 Apr 13;2009:274380. doi: 10.1155/2009/274380, PMID 19946418.
Kaviani N, Shahtusi M, Haj Norousali Tehrani MH, Nazari S. Effect of Oral Midazolam Premedication on Children’s Co-operation Before General Anesthesia in Pediatric Dentistry. J Dent (Shiraz). 2014 Sep;15(3):123-8. PMID 25191661.
Kumari S, Agrawal N, Usha G, Talwar V, Gupta P. Comparison of oral clonidine, oral dexmedetomidine, and oral Midazolam for premedication in pediatric patients undergoing elective surgery. Anesth Essays Res. 2017 Jan;11(1):185-91. doi: 10.4103/0259-1162.194586, PMID 28298782.
Verma RK, Paswan A, De A, Gupta S. Premedication with midazolam nasal spray: an alternative to oral midazolam in children. Anesth Pain Med. 2012;1(4):248-51. doi: 10.5812/aapm.4567, PMID 24904809.
Becker DE. Pharmacodynamic considerations for moderate and deep sedation. Anesth Prog. 2012;59(1):28-42. doi: 10.2344/0003-3006-59.1.28, PMID 22428972.
Parnis SJ, Forte JA, Van der Walt JH, Short T, Crowe CE. Oral Midazolam is an effective premedication for children having day-stay anesthesia. Anaesth Intensive Care. 1992 Feb;20(1):9-14. doi: 10.1177/0310057X9202000102, PMID 1609951.
Singh V, Pathak M, Singh GP. Oral Midazolam and oral butorphanol premedication. Indian J Pediatr. 2005 Sep;72(9):741-4. doi: 10.1007/BF02734144, PMID 16186674.
Savla JR, Ghai B, Bansal D, Wig J. Effect of intranasal dexmedetomidine or oral midazolam premedication on sevoflurane EC50 for successful laryngeal mask airway placement in children: a randomized, double-blind, placebo-controlled trial. Paediatr Anaesth. 2014 Apr;24(4):433-9. doi 10.1111/pan.12358, PMID 25229980.
Kalibatienė L, Kalibatas V, Macas A, Trepenaitis D. An evaluation of the effectiveness and safety of Midazolam in children undergoing dental surgery. Medicina (Kaunas). 2015 Jun;51(3):180-6. doi: 10.1016/j.medici.2015.04.001, PMID 28705481.
Tazeroualti N, De Groote F, De Hert S, De Villé A, Dierick A, Van der Linden P. Oral clonidine vs. Midazolam in preventing sevoflurane-induced agitation in children. A prospective, randomized, controlled trial. Br J Anaesth. 2007 May 1;98(5):667-71. doi: 10.1093/bja/aem071, PMID 17416907.
Yang CQ, Yu KH, Huang RR, Qu SS, Zhang JM, Li YL. Comparison of different sedatives in children before general anesthesia for elective surgery: A network meta-analysis. J Clin Pharm Ther. 2022 Oct;47(10):1495-505. doi: 10.1111/jcpt.13763, PMID 36029118.
Wang L, Huang L, Zhang T, Peng W. Comparison of intranasal dexmedetomidine and oral Midazolam for premedication in pediatric dental patients under general anesthesia: a randomized clinical trial. BioMed Res Int. 2020 Apr 24;2020:5142913. doi: 10.1155/2020/5142913, PMID 32382556.
Mountain BW, Smithson L, Cramolini M, Wyatt TH, Newman M. Dexmedetomidine as a pediatric anesthetic premedication to reduce anxiety and to deter emergence delirium. American Association of Nurse Anesthesiology [journal]. AANA J. 2011 Jun 1;79(3):219-24. PMID 21751690.
Cox RG, Nemish U, Ewen A, Crowe MJ. Evidence-based clinical update: does premedication with oral Midazolam lead to improved behavioral outcomes in children? Database of abstracts of reviews of effects (DARE): quality-assessed reviews [internet]; 2006 [cited 21/4/2023].
Lourenço‐Matharu L, Ashley PF, Furness S. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2012;2012(3): CD003877. doi 10.1002/14651858.CD003877.pub4, PMID 22419289.
Ashley PF, Chaudhary M, Lourenço‐Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2018;12(12): CD003877. doi 10.1002/14651858.CD003877.pub5, PMID 30566228.
Hisham AR, Mohamad F, Ali I, Nik Abdul Ghani N, Wan Ahmad WM, Samsudin N. Behavioral outcome of oral midazolam premedication in pediatric dental general anesthesia: A systematic review. J Int Oral Health. 2022 Nov 1;14(6):531. doi: 10.4103/jioh.jioh_161_22.
Elsherif N, Lewney J, John JH. Impact of Canceled General Anaesthetic dental extraction appointments on Children Due to the COVID-19 Pandemic. Community Dent Health. 2021 Aug 31;38(3):209-14. doi: 10.1922/CDH_00015Elsherif06, PMID 34218535.
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Copyright (c) 2023 Abdul Rauf Badrul Hisham, Noraida Mamat, Ahmad Faisal Ismail, Wan Muhamad Amir W Ahmad, Dr. Norsamsu Arni Samsudin
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