Comparison of sublingual lorazepam with intramuscular diazepam as sedatives during oral surgery

Sublingual lorazepam (2 to 3 mg) was compared with intramuscular diazepam (0.25 mg/kg) and placebo for sedation during oral surgery under local anesthesia. Sixty patients were randomly allocated into three groups in this double-blind, parallel study. The results from this trial show that sublingually administered lorazepam provided good sedation and anxiolysis. More side-effects, such as giddiness, dizziness, and ptosis, as well as profound and prolonged psychomotor impairment, were, however, found in the lorazepam group than in those patients who had received intramuscular diazepam (0.25 mg/kg) or placebo.     

Evaluation by thoracic impedance cardiography of diazepam, placebo, and two drug combinations for intravenous sedation of dental outpatients

The cardiovascular and respiratory effects of three common intravenous premedicants were examined noninvasively in a population of 20 dental outpatients scheduled for surgical removal of third-molars. Two third molars from one side of the mouth were removed at each appointment. Group 1 received a diazepam titration (mean dose = 25.6 mgs) at one appointment and placebo at the other appointment. Group 2 received a combination of diazepam (12.5 mg), fentanyl (0.1 mg), and methohexital (mean dose = 18.0 mg) at one appointment and the combination of diazepam (15.0 mg) and methohexital (mean dose = 27.0 mg) at the other appointment. Noninvasive measurement of cardiac output revealed little change during intravenous drug administration, but a significant increase was seen in all groups following local anesthesia and during surgery. Heart rate was elevated and stroke volume decreased during administration of the two-drug combinations. Oxygen saturation was greatly decreased following the combination of diazepam, fentanyl, and methohexital. These findings indicate that the combination of diazepam, fentanyl, and methohexital results in decreased oxygen saturation, a transient decrease in stroke volume, and an elevated heart rate when used as an intravenous premedicant for dental outpatients.     

A comparative study of intravenous diazepam and midazolam for oral surgery

Intravenous diazepam was compared with intravenous midazolam for conscious sedation in a single-blind study of 50 Hong Kong Chinese patients acting as their own controls. Verrill's sign was used as the end-point of sedation, and bilateral, similarly impacted lower third molars served as the surgical model. The drugs produced comparable levels of sedation, stable vital signs, and good operating conditions in all patients. Midazolam had numerous advantages over diazepam: more rapid onset of sedation, less pain during injection, profound anterograde amnesia, and fewer postoperative complications. The incidence of thrombophlebitis was low with both drugs and appears to be so in Chinese in general. A significant majority of the patients preferred sedation to other techniques and midazolam to diazepam.     

Improved sedation for oral surgery by combining nitrous oxide and intravenous Midazolam: a randomized, controlled trial

The objective is to investigate whether sedation techniques for oral surgery can be improved by combining the use of inhalation of nitrous oxide/oxygen with intravenous Midazolam. Prospective, randomized controlled clinical trial: Patients requiring extractions or surgery were randomly allocated to subgroups receiving either intravenous Midazolam or nitrous oxide/oxygen or a combined technique using nitrous oxide/oxygen and intravenous Midazolam. Safety parameters, amount of sedative agents administered, recovery time and co-operation scores were recorded. Patients receiving the combined sedation technique were initially titrated with 10% nitrous oxide, increasing by increments of 10% up to a maximum of 40% nitrous oxide and 60% oxygen. Midazolam was then titrated (initially 2 mg wait 2 min with increments of 1mg every minute until appropriately sedated) whilst still administering 40% nitrous oxide. When a combined technique of N(2)O/O(2) and Midazolam was used there was a statistically significant reduction in the amount of Midazolam required to achieve effective sedation (P<0.001), an overall significant reduction in recovery time (P<0.001) and a significant improvement in co-operation (P<0.01) and arterial oxygen saturation (P<0.001). This combined technique was found to be safe and reliable, requiring reduced doses of Midazolam and demonstrable improvement in patient recovery and co-operation.     

A double-blind comparison of nalbuphine and meperidine hydrochloride as intravenous analgesics in combination with diazepam for oral surgery outpatients

This study compared the analgesic efficacy, sedative, and amnesic properties, and side effects of nalbuphine versus meperidine as intravenous premedicants in combination with intravenous diazepam for the treatment of outpatients undergoing the removal of impacted third molars with alveolar nerve block anesthesia. Forty patients were evaluated in this double-blind crossover study. Nalbuphine was shown to have analgesic, sedative, and amnesic properties similar to meperidine. Nalbuphine, when compared to meperidine, produced significantly lower intraoperative systolic and diastolic blood pressures. Because of this cardiovascular stability, nalbuphine should be considered over meperidine for use in the cardiovascularly compromised patient undergoing oral surgery.     

Effects of intravenous midazolam and diazepam on patient response, percentage of oxygen saturation, and hemodynamic factors during periodontal surgery

BACKGROUND: The purpose of this double-masked study was to evaluate effects of intravenous sedation (IVS) using midazolam or diazepam during periodontal procedures on patient recall, psychomotor response, oxygen saturation, and hemodynamic factors. METHODS: Seventeen patients received either two or three scheduled periodontal surgeries under IVS with midazolam, diazepam, or placebo control. Patients were monitored throughout the procedure for hemodynamic variables, percent oxygen saturation, level of recall of common objects presented at baseline, and psychomotor function via the perceptual speed test (PST). RESULTS: Fifteen patients completed the study with average titrated dosages of 3.3 and 12.1 mg for midazolam and diazepam, respectively. Within the limitations of the study, there were few differences observed between the drugs with regard to hemodynamic variables, oxygen saturation, and overall percentage of objects recalled by patients sedated with either drug. However, midazolam was found to cause a greater incidence of amnesia lasting up to 30 minutes when compared to placebo. Patients on diazepam required an average of 15 minutes longer to recover accuracy as measured by the PST. CONCLUSIONS: The results suggest that diazepam and midazolam each may have advantages for IVS. In procedures lasting over 45 minutes, diazepam appears to be more clinically advantageous including a wider margin of safety during titration and gradual recovery. Midazolam may be used for shorter procedures for faster onset of action, predictable amnesic effects, and relatively rapid recovery.     

Double-blind comparison of nalbuphine and meperidine in combination with diazepam for intravenous conscious sedation in oral surgery outpatients

Nalbuphine and meperidine were compared as analgesic components of intravenous conscious sedation in a double-blind, prospective trial of 47 patients undergoing elective oral surgery. Subjects were evaluated for pain intensity, pain relief, anxiety, sedation, recall, and vital signs at systematic observation points intraoperatively and postoperatively. At the conclusion of surgery 83% of patients who had received nalbuphine and 86% of patients treated with meperidine indicated complete pain relief. One observed adverse reaction was attributed to meperidine and another to the sedative component diazepam. No statistically significant differences were observed between nalbuphine and meperidine treatments.     

Comparison of various physiologic and psychomotor parameters in patients sedated with intravenous lorazepam, diazepam, or midazolam during oral surgery

Intravenously administered lorazepam (0.05 mg/kg), diazepam (0.25 mg/kg), and midazolam (0.1 mg/kg) were compared for sedation during oral surgery under local anesthesia. Sixty patients were randomly allocated into three groups in this double-blind, parallel study. The results from this trial show that all three drugs provide satisfactory sedation. Average mean arterial pressures, however, decreased significantly with midazolam and diazepam. Statistically significantly higher heart rates during the entire procedure were also found for lorazepam when compared with diazepam and midazolam. At the postblock stage, the midazolam group had respiratory rates that were significantly higher than those of the other two drug groups. Patients in the diazepam and midazolam groups took significantly longer to complete the pegboard test at the preblock stage than those in the lorzepam group. At 1, 1.5, and 2 hours after arrival in the recovery room, an inversion of groups took place, with the lorazepam group taking significantly longer for their tests than the other two groups. Significantly more improvement in anxiety levels was found at 10 minutes postdrug for the patients who had received diazepam and this tended to remain so on arrival in the recovery room. When compared with the other two groups, significantly more patients in the lorazepam group reported giddiness/dizziness and significantly more in the diazepam group reported pain on injection.     

Amnesia,pain experience,and patient satisfaction after sedation with intravenous diazepam

Recovery time, the effect of sedation or amnesia on postoperative pain, and patients' opinions of the sedation were studied. Forty operations were performed on 20 patients. Each patient had four impacted third molars removed in two sessions, one in which a new emulsion form of diazepam (Diazemuls^®) was used, and one in which no sedation was used. The recovery from sedation was found to be very individual and not related to the dose administered, as assessed by a simple, easy-to-use method. There was no difference in postoperative pain between the sedated and unsedated groups, and we found no correlation between postoperative pain and amnesia. Eighty-five per cent of the patients preferred sedation during surgery, even though none of them had a preoperative indication for sedation.     

Smoking as a risk factor for dental implants and implant-related surgery

Cigarette smoking is known to adversely affect wound healing, and thus may jeopardize the success of dental implantation and implant-related oral surgery. The present study is aimed to present the influence of cigarette smoking on the success and survival of dental implantation as well as on the complication and success of implant-related surgery. We conclude that smokers undergoing both implant-related surgical procedures and dental implantation should be encouraged by their dentists, oral and maxillofacial surgeons, or treating physicians to cease smoking, emphasizing that smoking can increase complications and reduce the success rate of these procedures.     

Comparative evaluation of Midazolam and Propofol as intravenous sedative agents in the management of unco-operative children

Dental treatment of very young children (toddlers) as well as children with highly negative behaviour is known to be difficult. Management of these children requires special skill and at times the support of pharmacological means. A study was planned and carried out to evaluate and compare the efficacy and safety of Propofol and Midazolam as Intravenous sedative agents in the management of uncooperative children belonging to age group 2-5 years, ASA I Category and Frankl's behaviour rating 1 and 2. The results showed both agents to be effective sedative agents, for short pedodontic procedures with minimal side effects.     

Comparison of sedation,amnesia, and patient comfort produced by intravenous and rectal diazepam

In a cross-over study, intravenous diazepam was compared with rectal diazepam for sedation in outpatient oral surgery. Fifty-four operations were performed on 27 patients. Recovery from sedation, experience during the postoperative course, amnesia, estimation of the sedative effect, and patient preference of method of sedation were studied. The recovery times of the sedation methods did not differ. Sedative effects after the first operation were estimated as good by 87% of patients given intravenous sedation and by 75% of those given rectal sedation. However, there was a significant relationship between the subjective experience of stronger sedative effect and preference of sedation method that favored the intravenous technique. The degree of amnesia was significantly higher during intravenous sedation, but a high degree of amnesia was not related to patients' preference for a sedation method. Neither sedation method produced any local side effects.