The Sedation of Sublingual Administration of Midazolam.

-Part 2 Clinical Usefulness-

Abstract

The purpose of this study was to evaluate the clinical usefulness of sedation using sublingual administration of midazolam together with nitrous oxide/oxygen inhalation. The clinical usefulness was evaluated by the evaluation of the clinical sedative effects, and the status of adverse effects and discharge.
The subjects were 21 mentally handicapped patients, aged 6 to 21 years, all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under nitrous oxide/oxygen inhalation sedation. In this study, they received 0.2 mg/kg of sublingual instillation of midazolam, then received dental treatment with nitrous oxide/oxygen inhalation (20-40% N₂O/80-60% O₂).
Four of the 21 patients (19.0%) exhibited combative and resistant behavior toward the sublingual administration of midazolam. The initial sedative effects appeared within 5-10 minutes after sublingual midazolam administration. One patient rejected the nasal mask and refused to inhale the nitrous oxide/oxygen. The range of the success rate evaluated as both “markedly effective” and “effective” in each dental procedure was 65.0-90.5%. The injection of local anesthesia showed the lowest success rate among all of the procedures. The majority of the patients recovered within 150 minutes of the sublingual instillation of midazolam. At no time during the course of this study were any adverse effects observed.
Sixteen of the 21 patients (76.2%) were able to keep midazolam in their sublingual for more than 21 seconds. The rate of the clinical usefulness was 76.2%. The clinical usefulness tended to be influenced by the length of time of keeping midazolam in the sublingual. Comparing the clinical usefulness of keeping midazolam in the sublingual more than 21 seconds and of less than 21 seconds, we found that better effect was obtained from the former case. We believe that this technique is a useful conscious sedation during dental treatment.