Oral midazolam reduces cortisol levels during local anaesthesia in children: a randomised controlled trial

Abstract

Little is known about whether midazolam sedation can reduce salivary cortisol levels and consequently influence children's behaviour during dental treatment. The aim of this study was to evaluate the effect of midazolam sedation on salivary cortisol and its correlation with children's behaviour during restorative dental treatment. Eighteen healthy children, aged two to five years, were randomly assigned to two dental treatment appointments, both with physical restraint: oral midazolam 1 mg/kg (MS) and placebo (PS). An observer assessed the children's behaviour (videos) using the Ohio State University Behavioral Rating Scale (OSUBRS). The children's saliva was collected just after waking up, on arrival at the dental school, 25 minutes after local anaesthesia, and 25 minutes after the end of the procedure. Salivary cortisol levels were determined using the enzyme-linked immunoabsorbent assay. The data were analysed by bivariate tests and multivariate analysis of variance (5% level). Salivary cortisol levels were lower in the MS group than in the PS group at the time of anaesthesia (p = 0.004), but did not vary during the appointment within sedation (p = 0.319) or placebo (p = 0.080) groups. Children's behaviour was negative most of the time and did not differ between MS and PS; however, the behaviour (OSUBRS) did not correlate with salivary cortisol levels. Oral midazolam is able to control salivary cortisol levels during dental treatment of pre-schoolers, which might not lead to better clinical behaviour.

Crossover Studies of Pediatric Dental Sedation are Inappropriate

“…This study was approved by the Research Ethics Board of the Federal University of Goias, Brazil (protocol #307/2011) and registered in the Clinical Trials database (NCT01795222). The main findings of this study have already been published (11).…”

Cortisol salivar e atenção auditiva sustentada

“…(Sarsted). Este dispositivo comercial é uma maneira comum e muito utilizada para obtenção de saliva para análise em adultos (Aardal e Holm 1995, Kirschbaum et al 1996, Wust et al 2000b , Vedhara et al 2000, Lindauer et al 2005, Gallagher et al 2006, Keller 2006, Kanegane 2007, Roelofs et al 2007, Ferreira 2011, Gassling et al 2012, Henckens et al 2012, Abu-Samak et al 2014, Campos e David 2014, Lima 2014, Qi et al 2016) e crianças (Tornhage 2002, Groschl et al 2003, Rosmalen et al, 2005, Curcio et al 2013, Gomes et al 2015, Nederhof et al 2015, Gomes et al 2016, Saliba et al 2016). permanece sem alterações por três meses, quando armazenado a 5 °C, ou até um ano, quando congelado de -20°C a -80°C (Groschl et al 2001, Garde e Hansen 2005.…”

“…As formas mais indicadas pelos diferentes autores para armazenamento de cortisol salivar, no dia da coleta, são: congelamento a -20°C (Riad-Fahmy et al 1982, Aardal e Holm 1995, Kiess et al 1995, Kirschbaum et al 1996, Ellenbogen et al 2002, Lindauer et al 2005, Amenábar 2006, Gallagher et al 2006, Kanegane 2007, Roelofs et al, 2007, McCarthy et al 2009, Gassling et al 2012, Abu-Samak et al 2014), -25°C (Henckens et al 2012), -70°C (Morelius et al 2004) ou -80°C (Gomes et al 2015, Gomes et al 2016, Qi et al 2016.…”

“…O cortisol presente nas amostras de saliva foi mensurado por um kit imunoensaio enzimático (Salimetrics, Stage College, PA, USA) 14,71 9,76 17,50 16,40 8 4,36 4,3 2,80 22,71 8,54 21,83 16,17 1,42 1,27 3 2,28 10,66 6,96 8 8,37 7,22 6,04 3 2,16 17,89 11,30 11 8,41 1,6 1,58 2,5 Kirschbaum et al 1996, Vedhara et al 2000, Wust et al 2000b , Ellenbogen et al 2002, Tornhage 2002, Groschl et al 2003, Lindauer et al 2005, Rosmalen et al 2005, Gallagher et al 2006 Gomes et al 2015, Nederhof et al 2015, Qi et al 2016, Saliba et al 2016.…”

“…relatam valores que variavam de 1,90 a 16,02 nmol/L para crianças de 10 a 12 anos e Tornhage e Alfven(2006) encontraram níveis matinais de 8,8 nmol/L em crianças de seis a 15 anos. diferença entre os resultados obtidos nesta pesquisa com os deGomes et al (2015) eGomes et al (2016), também pode estar pautada por diferenças ocorridas durante a análise da saliva. Os kits de análise são…”