Analysis of the effect of oral midazolam and triazolam premedication before general anesthesia in patients with disabilities with difficulty in cooperation

Abstract

BackgroundWhen performing dental treatment under general anesthesia in adult patients who have difficulty cooperating due to intellectual disabilities, anesthesia induction may be difficult as well. In particular, patients who refuse to come into the dental office or sit in the dental chair may have to be forced to do so. However, for adult patients with a large physique, physical restraint may be difficult, while oral sedatives as premedication may be helpful. Here, a retrospective analysis was performed to investigate the effect of oral sedatives.MethodsA hospital-based medical information database was searched for patients who were prescribed oral midazolam or triazolam between January 2009 and December 2017. Pre-anesthesia evaluation, anesthesia, and anesthesia recovery records of all patients were analyzed, and information on disability type, reason for prescribing oral sedatives, prescribed medication and dose, cooperation level during anesthesia induction, anesthesia duration, length of recovery room stay, and complications was retrieved.ResultsA total of 97 patients were identified, of whom 50 and 47 received midazolam and triazolam, respectively. The major types of disability were intellectual disabilities, autism, Down syndrome, blindness, cerebral palsy, and epilepsy. Analyses of changes in cooperation levels after drug administration showed that anesthesia induction without physical restraint was possible in 56.0% of patients in the midazolam group and in 46.8% of patients in the triazolam group (P = 0.312).ConclusionsWith administration of oral midazolam or triazolam, general anesthesia induction without any physical restraint was possible in approximately 50% of patients, with no difference between the drugs.

Dental treatment under general anesthesia for patients with severe disabilities

“…A study on the effectiveness of different administrative routes of midazolam suggests that oral midazolam is more commonly recommended than intramuscular injection for patients with intellectual disability [ 23 ]. Furthermore, a study comparing the patients changing cooperative levels after receiving two different types of oral premedication, midazolam, and triazolam, concluded that the effects of the two drugs were not significantly different [ 24 ].…”

Difficult intubation caused by an immature upper airway in a patient with cri-du-chat syndrome: a case report

“…Since the evaluation of the Mallampati score depends on verbal commands, the amount of mouth opening and movement of the neck could not be confirmed; airway evaluation was conducted by carefully observation of the patient's movements. No abnormalities were observed but a difficult airway was expected considering the thyromental distance between the lower jaw and thyroid gland and protrusion of the anterior teeth [7].…”

Psychoprophylaxis for oral conscious sedation for dental care in Down syndrome adults with behavioral disorder

“…The hypnotic agents produce somnolence and facilitate the onset and maintenance of a state of natural sleep in its electroencephalographic parameters from which the patient can be easily awakened and respond appropriately to physical stimulation and verbal command . Oral midazolam, a benzodiazepine, has been used successfully in accident and emergency medicine since 1992, and there are numerous studies on its use as premedication . Indications for conscious sedation include moderate mental and psychological disorders, such as DS, and it is often indicated for children undergoing dental treatment …”

“…It is for all these reasons that it is necessary to implement strategies for the dental treatment of patients with intellectual disabilities. The most frequent is the use of general anesthesia with or without the use of midazolam as a premedication to reduce the traumatic experience . One of these strategies is conscious sedation after psychoprophylaxis sessions.…”

“…The most frequent is the use of general anesthesia with or without the use of midazolam as a premedication to reduce the traumatic experience. 14 One of these strategies is conscious sedation after psychoprophylaxis sessions. The psychoprophylaxis is a therapeutic process aimed at preventing the potential adverse psychological effects, reducing the potential psychological stress and emotional distress associated with the treatment procedures, and facilitating biopsychosocial recovery, by helping the person to develop resources that will improve his/her affective and cognitive functioning and behavior, in order to increase person acceptance of treatment.…”