Clinical Significance
Significant or major side effects appear to be uncommon when midazolam is used for
InquiryMidazolam sedation
Section snippets
Background
Young children who need multiple procedures often cannot be managed using local anesthesia alone, and general anesthesia can be accompanied by significant morbidity and expense. Sedation can help to manage behavior in pediatric patients, but its use is not supported by a strong base of evidence. Midazolam given orally has been shown to be effective in dental procedures for children and offers not only oral administration but also anxiolytic and anterograde amnesic effects while remaining short
Methods
The published literature was reviewed to find studies detailing the safety and side effects of oral midazolam used in pediatric dentistry. Side effects were noted and classified as significant or minor. The category “paradoxical reactions” was defined as confrontational or defiant behavior, disinhibition, belligerent behavior, crying, and agitation. Calculations were carried out to determine the percentage prevalence of these side effects per episode of treatment. Sixteen papers were selected.
Results
The reports of randomized controlled trials found no significant side effects with the use of midazolam for sedation in children undergoing dental procedures. Minor adverse events developed in 14% of the cases, with nausea and vomiting being the most common. The non-randomized study reports noted no significant adverse events, but minor adverse events in 8% of cases. The most commonly reported side effect was paradoxical reaction.
Discussion
Overall the studies differed widely in their reports of minor side effects, with some detecting none and others noting them in up to 50% of patients. The terms and classifications used for side effects, especially paradoxical reactions, varied considerably. Some may actually have been the result of insufficient sedation and failure of the procedure rather than a true paradoxical reaction.
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Papineni A, Lourenço-Matharu L, Ashley PF: Safety of oral midazolam sedation use in paediatric dentistry: A review. Int J Paediatr Dent 24:2-13, 2014
Reprints available from A Papineni, Unit of Paediatric Dentistry, Eastman Dental Hosp, 256 Gray's Inn Rd, London WC1X 8LD, UK; e-mail: [email protected]
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