The Effect of Adding Midazolam to Propofol Intravenous Sedation to Suppress Gag Reflex During Dental Treatment

Abstract

We retrospectively investigated the efficacy and safety of propofol administration alone and in combination with midazolam for gag reflex suppression during dental treatment under intravenous sedation. We included 56 patients with an overactive gag reflex who were to undergo dental treatment under intravenous sedation. They were divided into propofol (P group, n = 22) and midazolam with propofol (MP group, n = 34) groups. The P group received propofol alone, while the MP group received midazolam (0.04 mg/kg) prior to target-controlled infusion (TCI) of propofol (titrated for adequate sedation). The patients' anesthetic records were evaluated for vital sign changes, adverse cardiovascular or respiratory event frequency, the number of forced treatment interruptions, and the TCI-predicted cerebral propofol concentration at gag reflex suppression (posterior tongue stimulation with a dental mirror). No significant differences were observed between the 2 groups preoperatively. There were no cases of forced interruptions or significant respiratory compromise in either group. Cardiovascular adverse event frequency was lower in the MP group than in the P group (all p < .05). Our results suggest that propofol, when combined with midazolam, minimized cardiovascular effects compared with propofol alone when used to suppress the gag reflex in patients during dental treatment under intravenous sedation.

A comparative study of propofol alone and propofol combined with midazolam for dental treatments in special needs patients

“…It should be noted that men, patients who underwent multiple dental procedures, and patients who received multiple sedation drugs were more likely to have side effects. Although previous studies have indicated that unfavorable side effects are small, [ 11 – 14 ] the absolute percent of side effects by sedation type was first reported in this study based on our large clinical surveillance.…”

“…A previous study also demonstrated that the use of intravenous conscious sedation with propofol only versus midazolam with propofol did not differ with regard to treatment time in general dental patients. [14] This study has some limitations. First, the procedures were not designed according to the objective of the study because this was a retrospective study.…”

“…A previous study also demonstrated that the use of intravenous conscious sedation with propofol only versus midazolam with propofol did not differ with regard to treatment time in general dental patients. [ 14 ]…”

Propofol with Varied Functions: A Potential Therapeutic Opportunity for Postoperative Nausea, Vomiting and Pruritus—A Narrative Review

“…In recent years, propofol has been used as an alternative way of reducing postoperative nausea and vomiting due to its antiemetic and anticonvulsant therapeutic properties [11] [12]. Due to its quick plasma clearance, it acts quickly but only lasts a short time [13] [14]. Rosillo-Menesesa et al demonstrated that propofol primarily acts on GABA receptors by increasing chloride ion conduction.…”

Moderate sedation by total intravenous remimazolam-alfentanil vs. propofol-alfentanil for third molar extraction: A prospective randomized controlled trial

“…Intravenous sedation has been widely used in dental procedures to minimize these unpleasant conditions (5,6). Advantages of this sedation method may include reduced patient anxiety (7-9), reduced post-operative pain (10), increased patient and surgeon satisfaction (11) and suppressed gag reflex (12). Propofol is the most commonly used intravenous anesthetic.…”