Venous complications of intravenous diazepam

In an attempt to clarity the confusion about venous complications from intravenous diazepam, a study of 2,468 consecutive oral surgery and general dentistry cases in which diazepam was used was undertaken. It was found that 7.9% of the patients experienced local phlebitis and 4.5%, thrombophlebitis during the week after the injection. These findings were correlated with age, weight, sexual gender, dosage, type and duration of procedure, and degree of apprehension experienced by the patient.     

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.     

An evaluation of the amnesic effects of diazepam sedation

Twenty subjects, 13 female and 7 male, aged 16 to 37 years, were studied to determine the effects on memory of intravenous sedation with diazepam (Valium). Three tests were performed: 1) the Weschler Logical Memory Scale; 2) memory of three geometric shapes; and 3) memory of three objects presented in a drawing. Logical memory items were presented before and after sedation; other tests were presented after sedation. Anterograde amnesia was produced by diazepam sedation. No retrograde amnesia was observed. A significant drug effect was found between the pre-drug and post-drug retention intervals (T+ = 2; P less than 0.005). Post-drug recognition scores were found to be approximately 42% of pre-drug recognition scores. The anterograde amnesia produced with diazepam was probably due to decreased arousal of the subject, and decreased attention to rehearsal of short-term memory stimuli, resulting in a lack of storage of the stimuli.     

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 comparison of chloral hydrate and diazepam sedation in young children

The purpose of this study was to compare a high and low dose of diazepam with chloral hydrate in the sedation of young children. Thirty healthy children between the ages of 20 and 48 months, with a mean age of 33.5 months, participated in the study. All children exhibited negative behavior during a screening visit and required at least two restorative appointments with the use of sedation. A dose of either 0.3 mg/kg or 0.6 mg/kg of diazepam at one visit and 50 mg/kg of chloral hydrate at another visit was administered in a double-blind manner. All children were restrained in a Papoose Board with auxiliary head restraint and received 50% nitrous oxide/oxygen during treatment. The degree of sleep, body movement, crying, pulse rate, respiratory rate, and blood oxygen saturation were monitored before and during the operative procedures. Vital signs remained essentially unchanged during treatment, except for transitory elevations of the pulse during periods of stimulation. There were no statistically significant differences among the three drug regimens with regard to movement and crying. Significantly more patients who received chloral hydrate were asleep than when either dose of diazepam was given during the first 60 min of treatment. The only side effect found was vomiting in one patient with both chloral hydrate and diazepam. It is concluded that the sedative effects of chloral hydrate and diazepam are similar when young children are sedated for dental treatment. The use of diazepam might be more advantageous because chloral hydrate produces more sleep during the first hour of treatment.     

Subanesthetic doses of ketamine,diazepam, and nitrous oxide for adult outpatient sedation

The use of ketamine in adults has been complicated by untoward hallucinatory emergence reactions. The addition of nitrous oxide and diazepam to subanesthetic doses of ketamine may be effective in decreasing these reactions. Adult patients were sedated for outpatient oral and maxillofacial surgery procedures using nitrous oxide, diazepam, and either fentanyl or ketamine. Postoperative questionnaires were used to evaluate hallucinatory reactions, amnesia, and patient acceptance. Comparison of the results of patients receiving ketamine and those receiving fentanyl revealed no statistical differences in hallucinatory reactions or patient acceptance. Amnesia was more complete in the ketamine than the fentanyl group.     

Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a prospective, randomized, double-blind trial in Swedish children aged 1.5-3.5 years.

The aim of this study was to compare rectal sedation with diazepam and rectal sedation with midazolam with regard to sedative effect, treatment acceptance, and amnesia. Ninety children, 1.5-3.5 years of age, consecutively referred for extractions of traumatized primary incisors were randomly sedated with diazepam (0.7 mg/kg body weight) or midazolam (0.3 mg/kg body weight). The study design was randomized and double-blind. The level of sedation (state of mind) was assessed prior to and 10 and 60 min after administration of the drug by use of a behavioral scale (Wilton). The children's acceptance of procedures was assessed using another behavioral scale (Holst) during administration of the sedative, application of topical anesthesia, injection of a local anesthesia, and extraction. Amnesia was evaluated by the parents on the following day, with the child being asked standardized questions. Parental ratings of the child's and their own distress during and after treatment were made on a visual analog scale (VAS). No differences were found between the sedatives concerning level of sedation during treatment, acceptance of procedures, or amnesia. At discharge, 60 min after administration of the sedative, the children receiving diazepam were significantly more agitated (P=0.006). Parental rating on a VAS of the child's discomfort after treatment was significantly higher in the diazepam group (P=0.006). There was a tendency for children with poor acceptance of the rectal administration to display a more negative acceptance of the dental treatment. In conclusion, the present results, in combination with known pharmacological advantages, indicate that midazolam is preferable in outpatients when sedation is needed and amnesia is desirable.     

Intravenous or rectal diazepam for outpatient sedation in minor oral surgery

In a randomized cross-over study on sedation in outpatient oral surgery, intravenous and rectal administration of diazepam were compared. The mean dose for intravenous diazepam was 0.22 mg X kg-1 (range 0.15-0.38) and for rectal diazepam 0.58 mg X kg-1 (range 0.50-0.71). The determining factors for the patients' preference for sedation method, apprehension, effect produced by the sedative, recovery from sedation and the postoperative course were studied. The patients preferred the session in which they experienced stronger effect, regardless of the route of administration. Patient preference for sedation method did not differ when optimal dose regimens were used, and a preset dose of 10 mg rectal diazepam did not produce the desired effect. Apprehension was significantly higher prior to and during the first operation than the second operation, and all patients recovered from sedation within 2 1/2 hours after the administration.     

Behavioral influences of rectal diazepam in solution on dental patients with mentally and physically handicapping conditions

The hypothesis of this study was to determine whether the use of rectal diazepam in solution would effectively modify the uncooperative behavior of patients with mentally and physically handicapping conditions during dental treatment. The sample consisted of 42 patients with mild to severe mentally handicapping conditions, 4 to 31 years old, who live in a homecare center. Supragingival and subgingival scaling and prophylaxis were attempted during a 5-minute period and the patient's behavior was assessed. Conscious sedation using a rectal solution of diazepam (Stesolid) was used for those patients with voluntary or involuntary uncooperative behavior that prevented treatment. Twenty-two subjects (52.4%) were treated without diazepam. The rectal solution of diazepam proved to be a significantly (P < .01) effective agent for behavior modification permitting the successful treatment of 16 (80%) of the 20 remaining subjects. The following behaviors were significantly modified: places hand(s) or arm(s) in front of mouth (P < .01); does not open mouth, lips held firmly together (P < 05); turns head to one side or side to side (P < 05); attempts to grab instruments (P < .05). No relationship was found between the results and the variables of medical history, gender, age, weight, quantity of diazepam administered, routine medication, pulse rate, blood pressure, and respiration.     

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.     

Continuous transcutaneous O2 and CO2 monitoring during conscious sedation for oral surgery

Continuous transcutaneous oxygen and carbon dioxide monitoring during conscious sedation using diazepam, fentanyl, and methohexital indicates that hypoxia occurs in all patients maintained on room air; 36% of the patients maintained on room air showed a decrease in transcutaneous oxygen of greater than 20 mg Hg. Although the use of supplemental O2 prevented hypoxia, the combination of diazepam, fentanyl, and methohexital depressed all of the patient's carbon dioxide chemoreceptors, resulting in a rise in carbon dioxide in the oxygen-supplemented patients as well as in the patients who were maintained on room air. The need for supplemental oxygen in patients sedated with diazepam, fentanyl, and methohexital is clearly established.     

高血压患者拔牙术前口服药物控制性降压263例回顾性分析

目的：回顾原发性高血压患者拔牙术前口服药物控制性降压前后血压和心率变化,探讨口服药物降低患者血压的有效性,从而提高高血压患者拔牙的安全性。方法：对1997年1月～2011年12月就诊的263例高血压拔牙患者,在分别服用安定、硝苯地平等药物及联合用药进行控制性降压后,将患者的临床资料根据高血压级别、性别和年龄进行回顾性统计分析。结果：术前药物控制性降压患者人数逐年增多。各组用药前后血压变化均有统计学意义。安定和安定联合硝苯地平降压作用良好,其中安定在高血压3级、男性和超过75岁的患者中降压效果明显;而安定联合硝苯地平在高血压2级、3级,女性和超过75岁的患者中降压效果明显,其差别均有统计学意义。单纯应用硝苯地平降压有效率最低。结论：术前药物控制性降压能够达到良好的降压效果,可有效提高高血压患者拔牙安全性。     

Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a prospective,randomized, double-blind trial in Swedish children aged 1.5-3.5 years

The aim of this study was to compare rectal sedation with diazepam and rectal sedation with midazolam with regard to sedative effect, treatment acceptance, and amnesia. Ninety children, 1.5-3.5 years of age, consecutively referred for extractions of traumatized primary incisors were randomly sedated with diazepam (0.7 mg/kg body weight) or midazolam (0.3 mg/kg body weight). The study design was randomized and double-blind. The level of sedation (state of mind) was assessed prior to and 10 and 60 min after administration of the drug by use of a behavioral scale (Wilton). The children's acceptance of procedures was assessed using another behavioral scale (Holst) during administration of the sedative, application of topical anesthesia, injection of a local anesthesia, and extraction. Amnesia was evaluated by the parents on the following day, with the child being asked standardized questions. Parental ratings of the child's and their own distress during and after treatment were made on a visual analog scale (VAS). No differences were found between the sedatives concerning level of sedation during treatment, acceptance of procedures, or amnesia. At discharge, 60 min after administration of the sedative, the children receiving diazepam were significantly more agitated (P = 0.006). Parental rating on a VAS of the child's discomfort after treatment was significantly higher in the diazepam group (P = 0.006). There was a tendency for children with poor acceptance of the rectal administration to display a more negative acceptance of the dental treatment. In conclusion, the present results, in combination with known pharmacological advantages, indicate that midazolam is preferable in outpatients when sedation is needed and amnesia is desirable.     

Diazepam (valium) in premedication. Experimental findings

The anxiolytic and analgesic effects of 10 mg of orally administered diazepam (Valium) were assessed on 10 volunteers. The electrodermal activity was recorded during two experimental sessions while cutaneous electrical stimulations were administered to the subjects. On one hand, the anxiolytic activity of diazepam could be observed by a decrease of both autonomic nervous system and anticipatory activities. On the other hand, an increase of the pain threshold could be shown under diazepam by lower responses to the stimulations. These results confirm that diazepam can be useful in anxious patients undergoing dental procedures.     

Diazepam in the treatment of temporomandibular joint dysfunction syndrome—A double blind study

The effect of diazepam on patients with temporomandibular joint dysfunction has been determined by means of a double blind cross-over trial using diazepam and a placebo.The effect of diazepam was significantly better than the placebo and was more effective in temporomandibular joint dysfunction that was mechanical in origin.     

Butorphanol/diazepam compared to meperidine/diazepam for sedation in oral maxillofacial surgery: a double-blind evaluation

Butorphanol and meperidine, each combined with titrated diazepam, 10 to 20 mg, were compared in a randomized, double-blind trial for their sedative-analgesic effects. The fifty patients underwent multiple dental extractions under local anesthesia and sedation in an outpatient clinic. Butorphanol was significantly superior to meperidine with respect to the diazepam dose required to achieve the target level of sedation, the total diazepam dose administered, the clinical level of sedation, the surgeon's overall evaluations of effectiveness and of sedation level, and several patient evaluation parameters measured at discharge from the recovery room and at follow-up interview. All study drugs were well tolerated. Butorphanol offers clinical advantages over meperidine when combined with diazepam for sedation analgesia in outpatient oral surgery.     

A technique for investigating the intensity and duration of human psychomotor impairment after intravenous diazepam.

The objective of this study was to evaluate the impairment of both psychomotor function and memory after intravenous administration of 17 to 28 mg. of diazepam to normal volunteers. A battery of tests, including word memory, Seguin form board, digit symbol, digit span, block design, and reaction time, was administered at set intervals to both drug and nondrug subjects. The diazepam group demonstrated both psychomotor and anterograde memory deficits which persisted throughout the 150-minute evaluation; but relative to the control group, the diazepam group had enhanced retrograde memory. These preliminary results indicate that even after subjects appear to be recovered from the effect;s of diazepam, residual psychomotor and memory impairment remain.     

A preliminary study on oxygen saturation levels of patients during periodontal surgery with and without oral conscious sedation using diazepam

BACKGROUND: Stress and anxiety alter respiratory rate and thereby alter oxygen saturation in the blood. Management of psychological stress in the dental office may help maintain blood gas homeostasis. One method of stress management is through the use of preoperative oral sedation. METHODS: The study population consisted of 13 patients scheduled to receive two quadrants of periodontal surgery at two different appointments. A randomized split-mouth crossover design was used with one quadrant of surgery involving preoperative oral sedation (diazepam) and local anesthetic, and the second using local anesthetic only. Oxygen saturation was monitored by pulse oximetry, which recorded the number of times saturation dropped below 95% in a given time period. Data were recorded at 5 time periods: 1) baseline; 2) from time of anesthetic administration to 20 minutes into surgery; 3) 21 to 40 minutes; 4) 41 to 60 minutes; and 5) 61 to 80 minutes into the surgery. Data were analyzed by a two-factor repeated measures ANOVA. The two within-group factors were treatment group and time. RESULTS: Results indicated no significant interaction between time and treatment (P > .05). However, data for groups over time suggested a trend supporting an interaction. The eta2 value of 0.124 suggested a moderate effect favoring the diazepam treatment. No significant difference was noted for the main effect of treatment and time. However, the eta2 value of 0.24 for treatment effect (diazepam versus no diazepam) suggested a meaningful difference between groups. Similarly the eta2 value of 0.135 for time suggested a moderate effect over time within-subjects. CONCLUSIONS: This study indicates that diazepam given orally in adult dosages does not cause significant respiratory depression, and is generally safe for those healthy patients who may require slight to mild sedation during periodontal surgery.     

Comparison of the effectiveness of oral diazepam and midazolam for the sedation of autistic patients during dental treatment

PURPOSE: This study was undertaken to compare the effectiveness of oral diazepam and midazolam in sedating autistic patients during dental treatment. METHODS: The treatment regimen consisted of nitrous oxide/oxygen inhalation in conjunction with oral administration of either diazepam 0.3 mg/kg or midazolam 0.5 mg/kg in a cross-over design study of 13 subjects aged 5.8 to 14.7 years. A drug was classified as being effective when over 70% of the patients taking the drug were judged as "success" in all 3 behavioral criteria: (1) sleeping; (2) body movement; and (3) crying behaviors. The study was observed by an independent clinician with an intraexaminer reliability of 88%. RESULTS: For sleeping behavior, midazolam was found to be significantly more effective than diazepam as the duration of stimulation increased (P<.05). For the movement and crying behaviors, midazolam also proved to be significantly more effective from the start of treatment through the 35- and 40-min markers, respectively (P<.05). For the remainder of treatment, however, there was no statistically significant difference in these behaviors between the trials (P>.05). Diazepam and midazolam were rated as 77% and 100% successful, according to the overall behavior evaluation criteria (P=.02). CONCLUSIONS: Both diazepam and midazolam were shown to be effective sedative agents, successfully and safely used to sedate autistic patients for dental treatment. Midazolam was significantly more effective than diazepam in those portions of the procedure with increased stimulation.     

Effects of diazepam (cercine) on the somatosensory evoked responses following tooth pulp stimulation in rat.

Effect of diazepam on the somatosensory evoked responses (SER) following tooth pulp stimulation was investigated in Wistar albino rats. The SERs were recorded from the contralateral surface of the skull with a silver ball electrode and 200 responses were averaged with a medical computer. Generally, SERs were found to be composed of a sequence of four components named P1 (first positive wave), N1 (first negative wave), P2 (second positive wave), and N2 (second negative wave) in a 100 msec analysis time. Diazepam enhanced only the amplitude of the P1 component to about 500% of the control, while it suppressed other N1, P2, and N2 components to about 30, 40, and 20% of the control, respectively. The maximum suppressed effect appeared about 30 min after the diazepam injection and the effect was maintained for about 150 min. One possible explanation for the present result is that the activities of the synapses mostly in cortical layter IV evoked by tooth pulp stimulation may be enhanced but the activities of the cortical cells may be suppressed by diazepam injection.