Midazolam-fentanyl analgo-sedation in pediatric dental patients--a pilot study

The objective of this study was to comparatively evaluate the effectiveness ofsubmucosalfentanyl when administered in conjunction with oral midazolam during pediatric procedural sedations.

Twenty three uncooperative ASA type I children who met the selection criteria were randomly assigned to receive either submucosal fentanyl (3 microg/kg) or placebo, along with oral midazolam (0.5 mg/kg). A triple blind, 2-stage cross-over design was adopted so that each child received both the regimens.

Transient oxygen desaturation was observed in 4 children who were sedated with the combination of oral midazolam and submucosalfentanyl. The overall success was 73.91% with oral midazolam and submucosal fentanyl regimen and 47.83% for oral midazolam and submucosal placebo regimen. The chances of 'satisfactorily'completing a 45 minute dental procedure in an uncooperative pediatric patient was 2.8 times more, when submucosalfentanyl was used along with oral midazolam.

Submucosal fentanyl appears to improve the short working time associated with oral midazolam. But the oxygen desaturation associated with this regimen necessitates further studies to evaluate the efficacy of this combination at relatively lower doses before being used routinely for pediatric procedural sedation and analgesia.