Moderate sedation using midazolam is a common problem encountered during dental treatment and often makes therapeutic procedures impossible because of anxiety and dental stimuli. We have reported that fentanyl depresses the gagging reflex as well as acting as a good analgesic and can be used for sedation-analgesia when combined with midazolam. We present two cases of patients with dental phobia who underwent smooth dental procedures under sedation-analgesia with a fentanyl-midazolam combination.
Respiratory and circulatory parameters (respiratory rate, end-tidal CO2 and oxygen saturation, blood pressure and heart rate) were recorded every 5 min during the intravenous sedation. A 17-year-old man and a 32-year-old woman received fentanyl (50 μg) just before procedure, followed by the injection of midazolam (2.0 mg) 2 min later ; fentanyl (25-50 μg) and/or midazolam (0.5-1.0 mg) was then administered as needed every 20-40 minutes during the procedure ; each patient received oxygen from a nasal cannula throughout. The two patients received total doses of 50 and 100 μg of fentanyl, respectively, and 5.0 and 4.0 mg of midazolam, respectively, during their dental procedures (15 and 107 min, respectively). Although the total midazolam doses were higher when combined with fentanyl than when midazolam is used alone, no adverse complications, such as respiratory or circulatory depression, were observed, and the patients remained cooperative during the dental treatment. Furthermore, the severity of dental phobia decreased with each subsequent dental procedure under sedation-analgesia with a fentanyl-midazolam combination.
In conclusion, sedation-analgesia with a combination of fentanyl and midazolam may reduce the frequency and/or intensity of dental phobia, potentially enabling dental treatment to be provided more comfortably to patients with dental phobia.
