Midazolam in conservative dentistry. A cross-over trial

Area of Science:

• Dental pharmacology
• Clinical trials
• Sedation techniques

Background:

• Intravenous sedation is commonly used in conservative dentistry to improve patient comfort and cooperation.
• Diazepam and midazolam are frequently used sedatives, but their comparative efficacy and side effect profiles require further investigation.
• Understanding recovery times and potential complications like venous thrombophlebitis is crucial for patient safety.

Purpose of the Study:

• To compare the efficacy and safety of intravenous diazepam versus midazolam in patients undergoing conservative dentistry.
• To assess operating conditions, physiological responses, recovery times, and the incidence of venous thrombophlebitis.
• To evaluate the amnesic effects of both sedatives.

Main Methods:

• A double-blind, randomized trial involving 50 patients undergoing conservative dentistry.
• Patients received either diazepam (0.29 mg/kg) or midazolam (0.14 mg/kg) intravenously in a crossover design.
• Data collected included operating conditions, physiological parameters, recovery ('street fitness'), venous thrombophlebitis, and amnesia.

Main Results:

• Both diazepam and midazolam provided good operating conditions with no significant physiological differences observed.
• Most patients did not achieve full 'street fitness' 30 minutes post-treatment for either sedative.
• The amnesic effect was reportedly stronger with midazolam in approximately half of the patients; venous thrombophlebitis data was inconclusive due to poor quality.

Conclusions:

• Intravenous diazepam and midazolam are effective sedatives for conservative dentistry, offering comparable operating conditions and physiological stability.
• Recovery to 'street fitness' is prolonged with both agents.
• Midazolam may induce a stronger amnesic effect, but further research is needed to confirm its impact on venous thrombophlebitis.