Intranasal midazolam for the sedation of geriatric patients with care-resistant behaviour during essential dental treatment: An observational study.
anaesthesia
gerodontology
sedation
Journal
Gerodontology
ISSN: 1741-2358
Titre abrégé: Gerodontology
Pays: England
ID NLM: 8215850
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
revised:
11
02
2021
received:
19
05
2020
accepted:
24
02
2021
pubmed:
23
3
2021
medline:
11
5
2022
entrez:
22
3
2021
Statut:
ppublish
Résumé
To describe the efficacy and safety of intranasal midazolam for sedation during essential dental treatment of geriatric patients with major neurocognitive disorder (MND) and care-resistant behaviour (CRB). Dental treatment is often impossible in geriatric MND patients with CRB. Intranasal midazolam may provide a non-invasive sedation method, but there is currently no information on its use in geriatric patients. In this observational study, we included geriatric patients with severe MND and CRB needing urgent dental treatment. Each patient received 5 mg midazolam intranasally. Agitation/sedation levels, heart rate, respiration rate and oxygen saturation were recorded at 5-minute intervals. Thirty two patients were included. Mean age was 84 (±7) years. Mean (SD) time to treatment start was 13 (±5) minutes, and mean time to maximum sedation 17 (±11) minutes. Sedation was sufficient to enable dental treatment to be completed in 31 (97%) patients. Anxiolysis/light sedation occurred in 16 (50%) patients, and moderate to deep sedation occurred in 16 (50%) patients. No patients suffered from apnoea, although 3 patients required a chin-lift manoeuvre. Hypoxaemia occurred in 1 of these patients and in 2 other patients without airway obstruction. All patients recovered uneventfully. In a regression model, age, weight and other sedative medication use were found not to be associated with maximum sedation depth. Of 5 mg intranasal midazolam facilitates treatment of geriatric patients with MND in the comfort of their own environment. More information is needed to guide titration to balance the desired sedation level and patient safety.
Sections du résumé
OBJECTIVES
OBJECTIVE
To describe the efficacy and safety of intranasal midazolam for sedation during essential dental treatment of geriatric patients with major neurocognitive disorder (MND) and care-resistant behaviour (CRB).
BACKGROUND
BACKGROUND
Dental treatment is often impossible in geriatric MND patients with CRB. Intranasal midazolam may provide a non-invasive sedation method, but there is currently no information on its use in geriatric patients.
METHODS
METHODS
In this observational study, we included geriatric patients with severe MND and CRB needing urgent dental treatment. Each patient received 5 mg midazolam intranasally. Agitation/sedation levels, heart rate, respiration rate and oxygen saturation were recorded at 5-minute intervals.
RESULTS
RESULTS
Thirty two patients were included. Mean age was 84 (±7) years. Mean (SD) time to treatment start was 13 (±5) minutes, and mean time to maximum sedation 17 (±11) minutes. Sedation was sufficient to enable dental treatment to be completed in 31 (97%) patients. Anxiolysis/light sedation occurred in 16 (50%) patients, and moderate to deep sedation occurred in 16 (50%) patients. No patients suffered from apnoea, although 3 patients required a chin-lift manoeuvre. Hypoxaemia occurred in 1 of these patients and in 2 other patients without airway obstruction. All patients recovered uneventfully. In a regression model, age, weight and other sedative medication use were found not to be associated with maximum sedation depth.
CONCLUSIONS
CONCLUSIONS
Of 5 mg intranasal midazolam facilitates treatment of geriatric patients with MND in the comfort of their own environment. More information is needed to guide titration to balance the desired sedation level and patient safety.
Identifiants
pubmed: 33749028
doi: 10.1111/ger.12550
pmc: PMC9291142
doi:
Substances chimiques
Hypnotics and Sedatives
0
Midazolam
R60L0SM5BC
Types de publication
Journal Article
Observational Study
Langues
eng
Pagination
161-169Informations de copyright
© 2021 The Authors. Gerodontology published by Gerodontology Association and John Wiley & Sons Ltd.
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