Cognitive properties of sedation agents: comparison of the effects of nitrous oxide and midazolam on memory and mood

Thompson, Jessica; Neave, Nick; Moss, Mark; Scholey, Andrew; Wesnes, Keith; Girdler, N.M.

doi:10.1038/sj.bdj.4800330

Cited by 35 publications

(22 citation statements)

References 22 publications

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“…Moreover, in ambulatory care settings where post-discharge 'street-fitness' becomes relevant, further concern attaches to the potential adverse effects of midazolam upon cognitive function. However, whilst the adverse effects of midazolam upon adult functioning are well established [4,5], relatively little is known of its effects upon children's cognition.…”

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confidence: 99%

A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition

et al. 2007

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SummaryThis randomised, placebo-controlled study assessed the effects of midazolam premedication on children's postoperative cognition and physical morbidity. In all, 179 children aged 5-10 years were randomly assigned to receive buccal midazolam (0.2 mg.kg) or placebo before sevofluranenitrous oxide anaesthesia for multiple dental extractions. They performed tests of choice reaction time, attention, psychomotor co-ordination and memory pre-operatively (baseline), before discharge and at 48 h. The reaction time of both groups was significantly slower before discharge compared to baseline, with the midazolam group being significantly slower than placebo. Psychomotor co-ordination was also significantly impaired postoperatively after midazolam. Performance on both tests had recovered to baseline by 48 h. Midazolam was also associated with significant anterograde amnesia, both postoperatively and at 48 h, for information presented in the interval between premedication and surgery. The results show significant short-term impairment of children's cognitive function and amnesia enduring for 48 h after low-dose midazolam premedication.

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confidence: 99%

A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition

et al. 2007

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“…Patients will not have the opportunity to expose themselves in vivo to procedures due to amnesic effects of the drugs given during intravenous sedation which may prevent habituation (anxiety reduction) from taking place . 15 The conclusions that can be drawn from this study are limited by the retrospective design, the size of the sample and the specialised setting chosen. It is not known if similar referral patterns occur in other parts of the UK, either in dental schools or other specialist centres for treating dental anxiety.…”

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confidence: 99%

“…A recent study by Aartman and colleagues found that behavioural therapy was effective for 46.5% of patients who attended a dental fear clinic for dental treatment. 15 Compared with 'easier' alternatives such as intravenous sedation or general anaesthesia, a behavioural approach requires commitment, engagement and courage from patients, which many may find difficult to consider. However, it is important to note that in many situations the application of these alternatives is only a short-term solution.…”

Section: Discussionmentioning

confidence: 99%

“…Practising dentists will recognise that they have a duty to offer patients all treatment options available (including behavioural techniques for which there is proven effectiveness) and to assign their patients to the most appropriate treatment modality for them to meet their individual needs. 15 Clinical psychologists accept referrals from a wide range of agencies and health professionals. Referring patients with dental anxiety problems is an example of an appropriate referral.…”

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confidence: 99%

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Referrals to a secondary care dental clinic for anxious adult patients: implications for treatment

et al. 2001

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“…1 The effect of midazolam on cognitive and psychomotor function is well established. 2 More recently Thompson et al 3 concluded that midazolam administration produces severe cognitive impairments, not only in the ability to both detect and process information but also in recalling specific aspects of information. The consequence of this is that patients will not recall information given during treatment.…”

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confidence: 99%

A randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period

et al. 2002

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335 RESEARCHA randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period Objective: To study the post-operative cognitive and psychomotor recovery from midazolam conscious sedation, after reversal with the benzodiazepine antagonist flumazenil over a prolonged recovery period. Design: A prospective, double-blind, randomised, crossover trial. Setting: Out-patient Sedation Department, Newcastle Dental Hospital and School Method: Eighteen patients, ASA I or II, received midazolam on two separate occasions to undergo equivalent dental treatment. Following treatment patients were reversed with intravenous flumazenil or saline (placebo) at alternate appointments. Assessment of mood and cognitive function was undertaken using a highly sensitive and specific computerised battery of cognitive tests administered by telephone. Cognitive and psychomotor tests were administered prior to sedation and every hour for 6 hours post reversal. Results: Results indicated no significant effect of flumazenil on simple reaction time and choice reaction time but did show a trend of reversing the effects of midazolam on numeric working memory and word recognition. Conclusion:The cognitive and psychomotor effects of the sedation were not fully reversed by flumazenil. Cognitive impairments were still present up to 6 hours post-reversal, despite patients appearing clinically more alert. This has important implications for treatment protocols and discharge instructions.

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Cognitive properties of sedation agents: comparison of the effects of nitrous oxide and midazolam on memory and mood

Cited by 35 publications

References 22 publications

A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition

A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition

Referrals to a secondary care dental clinic for anxious adult patients: implications for treatment

A randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period

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