Comparison of Sedative Efficacy of Oral Midazolam and Nitrous Oxide-Oxygen Sedation in Children Aged 5 -12 Years in Dental Clinic-An Invitro Study

Conscious sedation remains the most effective and popular pharmacological method for behavior management in children. The aim of the study was to compare the efficacy and acceptability of oral midazolam sedation with nitrous oxide-oxygen sedation for extraction of teeth under local anesthesia in children aged 5 to 12 years in a dental clinic set up. Patients were randomly allocated either for nitrous oxide-oxygen or oral midazolam. At first sedation visit nitrous oxide 50% in oxygen was used and oral midazolam 0.5 mg/kg at second visit or vice-versa. Vital signs, sedation level and behavioral scores of patient were recorded at preoperative, intra operative and postoperative interval. Postoperative adverse effects and amnesic effect was recorded by using a questionnaire. Out of forty children, 57.50% (23) were males and 42.50% (17) were females. The mean time for onset of sedation of midazolam and nitrous oxide-oxygen sedation were 23.30 minutes and 1.98 minutes, respectively. Oral midazolam was more effective than nitrous oxide-oxygen as a conscious sedative agent. The preference for future sedation and amnesic efficacy of oral midazolam was greater than nitrous oxide-oxygen sedation. Introduction Fear of dental treatment and anxiety about dental procedures are prevalent in pediatric patients. The quality of dental treatment performed is also affected both in terms of limited attendance for treatment and nature of the dental treatment likely to be performed. [1] Delay in seeking treatment as a result of dental anxiety often means that conservative treatment options are not viable. [2] Psychological behavior management techniques alone are not always adequate for gaining patient’s cooperation. Therefore, a definite need exists for pharmacological management of the problem. [3] Conscious sedation is used in pediatric dentistry as elsewhere to reduce fear and anxiety in pediatric patients and so promote favorable treatment outcomes. This can help to develop a long term positive psychological response to necessary dental procedures. Conscious sedation is a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command and that is produced by pharmacologic or non-pharmacologic method or combination thereof. In conscious sedation spontaneous ventilation and cardiovascular function is usually maintained which is highly desirable in pediatric dental sedation. [4] Various drugs and routes can be used for conscious sedation. Nitrous oxide is notable because of its impeccable safety record, which has withstood the test of time longer than any other drug. [5] The benzodiazepines like midazolam represent the most popular class of drugs available today for management of dental fear and anxiety via oral route of drug administration. [4] The aim of the study was to compare the efficacy and acceptability of oral midazolam sedation with nitrous oxide-oxygen sedation for extraction of teeth under local anesCase Report Open Access