Wednesday, February 22, 2012

Oral Midazolam with and without meperidine for management of the difficult young pediatric dental patient: a retrospecitive study

Oral Midazolam with and without meperidine for management of the difficult young perdiatric dental patient: a retrospective study

John E. Nathan, DDS, MDS
Kaaren G. Vargas, DDS, PhD

Pediatric Dentistry 24:2, 2002

Abstract: To examine the effectiveness of different dosages of midazolam used with or without meperidine to manage the difficult pediatric dental patient.

Methods: 120 patient records with sedation logs were reviewed. The subjects were divided into six groups based on dosages of midazolam alone or in combination with meperidine. 'Quality' of sedation was assessed as well as length of sedation; or working time and recovery time.

Higher doses of midazolam alone can produce better results in the severely apprehensive patient.
Children below the age of reason may require deeper levels of consciousness to permit invasive procedures
The addition of meperidine (1.0 mg/kg) doubled efficacy with 80% visits showing adequate or better ratings. In addition it also doubled working time from 8 to 18 minutes.
Higher doses of meperidine (1.0 mg/kg) did not show better results and warranted safety concerns for patients who were over sedated.

The definition of success varies from practitioner as well as parent. This was clearly evident from my short stay working in Hawaii. However, I do believe oral sedation is a good tool and option to use for some patients who are apprehensive about treatment. It can be very successful when used for the appropriately selected patient.

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