Remifentanil for use during conscious sedation in outpatient oral surgery.

PURPOSE: Remifentanil is a new, short-acting opioid that is similar pharmacodynamically to currently available opioids but differs in its pharmacokinetics. In the present study, we compared the use of remifentanil with the use of meperidine during intravenous conscious sedation for third molar surgery. PATIENTS AND METHODS: Forty patients who were scheduled for the removal of impacted third molars were randomly assigned to undergo 1 of 2 intravenous conscious sedation techniques. For both groups, 50:50 nitrous oxide oxygen were administered via nasal hood, and midazolam was titrated to Verril's sign. Twenty patients each then received either remifentanil 0.05 microgram/kg/min or meperidine 50 mg. Both patients and surgeons were blinded to the narcotic that was used. Blood pressure, heart rate, and oxygen saturation were determined before sedation and every 5 minutes during surgery. Recovery was measured using serial Trieger tests every 5 minutes after surgery. Patient and surgeon satisfaction of the quality of sedation was measured with a visual analog scale. RESULTS: Peak heart rate (91 beats/min for remifentanil vs 107 beats/min for meperidine, P <.01) and peak systolic blood pressure (131 mm Hg for remifentanil vs. 142 mm Hg for meperidine, P <.05) were significantly lower for the remifentanil group. Although there was a trend toward increased surgeon satisfaction with remifentanil (86 of 100 with remifentanil vs. 73 of 100 with meperidine), it was not found to be statistically significant. Likewise, other physiologic parameters were not found to be statistically significant. CONCLUSIONS: The lower peak heart rate and systolic blood pressure levels indicate that remifentanil may allow for less fluctuation in cardiovascular parameters. This could prove beneficial in patients with cardiovascular compromise.     

A comparison of midazolam and midazolam with remifentanil for patient-controlled sedation during operations on third molars

Our aim was to compare patients' satisfaction and cooperation, and clinical efficacy, of midazolam alone, and midazolam and remifentanil for patient-controlled sedation during removal of third molars. Forty patients, American Society of Anesthesiologists grades I and II, admitted for extraction of impacted mandibular third molars were included in this randomised, prospective study. They were given an intravenous bolus of midazolam 0.03 mg/kg and then allowed to use patient-controlled sedation. In the midazolam group, 2 ml of 0.5 mg/ml midazolam was given automatically. In the midazolam-remifentanil group, 2 ml of 0.5 mg/ml midazolam and 12.5 microg/ml remifentanil were given in the same manner. The lockout period was 5 min. Vital signs and oxygen saturation were recorded. Patients' and surgeons' satisfaction, and the patients' degree of amnesia about the local anaesthetic, drilling, removal of the tooth, and pain during extraction were also assessed. There were no significant differences between systolic and diastolic blood pressures during sedation, but heart rate after 30 min in the combined group was significantly lower than in the midazolam group (p<0.05). Surgeons described the midazolam group as excellent in 9 and good in 11. In the combined group, satisfaction was excellent in 11, good in 7, and satisfactory or unacceptable in 1 of each. Immediately postoperatively, 19 patients in each group ranked their satisfaction as excellent and 1 as good. Twenty-four hours later it was unchanged in the midazolam group, while 15 patients in the other group thought it was excellent, 3 good, and 2 poor. Patient-controlled analgesia with midazolam or midazolam and remifentanil is safe and reliable during extraction of third molars.     

盐酸咪达唑仑镇静药在阻生智齿拔除术中应用的临床观察

目的观察马来酸咪达唑仑（midazolam HCl）静脉输注提高下颌阻生智齿拔除时患者舒适度的效果。方法50例双侧下颌阻生智齿拔除难度基本相同的患者，采用自身对照设计，一侧采用盐酸咪达唑仑低流量（平均流量0．042±0．010mg·kg^-1）静脉输入，另一侧空白对照。结果试验组焦虑视觉模拟量表（visual analogue scale，VAS）平均得分21．4±12．2mm，疼痛VAS平均得分（6．92±9．50）mm，与对照组（35．9±18．2）mm；（16．4±12．4mm）比较，差异有统计学意义（P=0．000；P=0．000）。结论在拔除阻生智齿时，对轻度恐惧的患者应用盐酸咪达唑仑镇静，可以显著提高患者的舒适度。     

Dexmedetomidine versus midazolam in outpatient third molar surgery.

PURPOSE: The aim of this study was to compare the use of dexmedetomidine with the use of midazolam during intravenous conscious sedation in third molar surgery. PATIENTS AND METHODS: Twenty healthy patients with symmetrically impacted mandibular third molars were included in this double-blind, crossover, randomized study. Either dexmedetomidine (group D) (4 microg.kg(-1).h(-1)) or midazolam (group M) (0.4 mg.kg(-1).h(-1)) was administered intravenously for 15 minutes before the first operation. At the second operation, the other agent was applied. Cardiorespiratory data were collected. The intraoperative sedation level, patient cooperation, and postoperative performance were scored and any pain reaction during the local anesthetic injection was recorded. Visual analog scales were additionally used for the subjective assessment of pain and patient satisfaction. Amnesia was evaluated by the patients' ability to recall the objects shown during the operations and the local anesthetic injection. Patients' preferences were recorded during the interview at the end of the second operations. RESULTS: The mean heart rate and blood pressure measurements were significantly lower in group D. There was no significant difference in the respiratory findings. A significantly higher number of patients showed pain reactions in group M. Sedation level, postoperative performance, and VAS pain scores were not statistically significant, whereas the differences in cooperation score and VAS for patient satisfaction were significant. Adequate amnesia was obtained in group M, however, no amnesia was demonstrated in group D. Sixty-five percent of the patients indicated a preference for dexmedetomidine sedation. CONCLUSION: Dexmedetomidine may be a remarkable alternative to midazolam for intravenous sedation because it seems to be a reliable and safe method, with additional analgesic effect providing a satisfactory sedation level without any serious side effects during impacted third molar surgery.     

Patient-maintained sedation for oral surgery using a target-controlled infusion of propofol - a pilot study

OBJECTIVE: To assess the safety and efficacy of a new patient-maintained propofol system for conscious sedation in dentistry. DESIGN: Prospective clinical trial SETTING: Department of Sedation, Glasgow Dental Hospital and School, 2001 SUBJECTS AND METHODS: Patients scheduled for oral surgery with conscious sedation. Exclusions included ASA IV -V, inability to use the handset, opioid use and severe respiratory disease. INTERVENTIONS: Patients were given intravenous propofol to a level of 1.0 microg/ml (reducing from 1.5 microg/ml) using a target controlled infusion system, they then controlled their sedation level by double-clicking a handset which on each activation increased the propofol concentration by 0.2 microg/ml. MAIN OUTCOME MEASURES: Oxygen saturation, patient satisfaction, and surgeon satisfaction. RESULTS: Twenty patients were recruited, 16 female and four male. Nineteen patients completed sedation and treatment successfully. Mean lowest oxygen saturation was 94%. No patients were over-sedated. All patients successfully used the system to maintain a level of sedation adequate for their comfort. Patient and surgeon satisfaction were consistently high. CONCLUSIONS: Initial experience with this novel system has confirmed safety, patient satisfaction and surgeon satisfaction.     

A study of the effectiveness of oral midazolam sedation for orthodontic extraction of permanent teeth in children: a prospective,randomised, controlled,crossover trial

OBJECTIVES: To assess the safety, effectiveness and acceptability of o:ral midazolam sedation for orthodontic extraction of permanent teeth in children. DESIGN: A prospective, randomised, controlled, crossover trial. METHODS: A total of 26 children aged 10-16 (ASA I), referred for orthodontic extraction of premolar or canine teeth under sedation, were included in the study. Each child required two treatment sessions for the extraction of equivalent teeth on opposite sides of the mouth. Each subject was sedated with either ora midazolam (0.5 mg/kg) or nitrous oxide and oxygen (30%/70%) at the first visit and the alternative form at the second visit. At each visit two teeth were extracted, one upper and one lower. Heart rate, arterial oxygen saturation, respiration rate, sedation and behavioural scores were recorded every five minutes. Overall behaviour, patient acceptance and patient satisfaction were recorded at the end of treatment. RESULTS: Of the 26 children included in the study there were 12 males and 14 females. The mean age was 12.5 years. The mean heart rate and respiratory rate for both groups were similar and within acceptable clinical limits. The lowest mean arterial oxygen saturation levels for nitrous oxide and midazolam sedation were 97.7% and 95.0% respectively. Although midazolam caused greater oxygen desaturation, the range (91%-100%) was within safe limits for conscious sedation. The mean level of sedation was greater in the midazolam group compared with the nitrous oxide group and all but one case completed treatment. A total of 23 patients (88%) said they would be prepared to have ora midazolam sedation again and 17 (65%) actually preferred oral midazolam to nitrous oxide sedation. CONCLUSION: Oral midazolam (0.5mg/kg) appears to be a safe and acceptable form of sedation for 10-16 year old paediatric dental patients.     

A comparison of 3 routes of flumazenil administration to reverse benzodiazepine-induced desaturation in an animal model

PURPOSE: The purpose of this study was to examine intralingual (IL) and submucosal (SM) delivery offlumazenil as viable alternatives to immediate intravenous (IV) administration for reversing benzodiazepine sedation in an animal model. METHODS: A dog animal model was chosen based upon comparable body weight to children (12-17 kg) and the ease of oral access in this species. Research design was a nonrandomized matched pair study. This type of "before-and-after study" allowed the dogs to receive 3 different routes of flumazenil administration (IV, IL, and SM) following an initial dose of midazolam (0.5 mg/kg IV). Blood samples were obtained (at 0, 2, 4, 8, 15, and 30 minutes) for high performance liquid chromatography (HPLC) analysis of flumazenil and midazolam, and oxygen saturation values were recorded. RESULTS: Both IL and SM delivery of flumazenil were determined to be viable alternatives to immediate IV administration for reversing benzodiazepine-induced oxygen saturation (SaO2) desaturation. For flumazenil to be able to reverse the SaO2 desaturation, the plasma levels must be greater than 5 ng/ml, which was exceeded by IL and SM drug delivery. CONCLUSION: In a benzodiazepine-induced desaturation, the submucosal and intralingual routes are viable alternatives to intravenous administration of flumazenil in an animal model.     

Comparison of a bolus of fentanyl with an infusion of alfentanil during target-controlled propofol infusion in third molar extraction under conscious sedation.

PURPOSE: This study was designed to compare hemodynamic changes, respiratory depression, and patient satisfaction between a bolus of fentanyl and an infusion of alfentanil during target-controlled propofol infusion in third molar extraction under conscious sedation. PATIENTS AND METHODS: Forty patients were randomly assigned to receive either a bolus of fentanyl (n = 24) or an infusion of alfentanil (n = 16) in combination with target-controlled propofol infusion. Hemodynamic changes, respiratory depression, sedation, and cooperation scores were recorded during surgery and patient satisfaction scores were assessed after surgery. RESULTS: Changes in mean blood pressure, heart rate, or oxygen saturation within and between the groups were not significant throughout the procedure. There were no significant differences in sedation, cooperation, and patient satisfaction scores between the 2 groups. CONCLUSION: Because there was no difference in hemodynamic variables and patient satisfaction scores between a bolus of fentanyl and an infusion of alfentanil during target-controlled propofol infusion, both combinations are suitable for conscious sedation in third molar extraction.     

Effects of low-dose midazolam with propofol in patient-controlled sedation (PCS) for apicectomy

We studied the effects of low-dose midazolam with propofol for patient control sedation (PCS) in 30 healthy (ASA grade I) patients who were randomly allocated into two equal groups (n = 15 in each). They were given a propofol infusion of 2mg/kg/h after a bolus dose of 0.7 mg/kg. The second group was given the 2mg/kg/h propofol infusion after a dose of midazolam 0.03 mg/kg and a bolus dose of propofol 0.7 mg/kg. The standard dose for PCS was propofol 0.2mg/kg in both groups. Clinical data were taken and haemodynamic variables, and oxygen saturation were recorded before and on the 5th, 10th, 20th, and 30th minutes during the operations. The level of sedation, amnesia and conditions of each patient were evaluated during the study. Patients' satisfaction was recorded using a modified visual analogue scale (VAS). All results were evaluated statistically. We conclude that low-dose midazolam with propofol during PCS neither reduced oxygen saturation nor prolonged the time of discharge. Low-dose midazolam with propofol also improved the acceptability and comfort for patients and made the operation easier, which makes it preferable to propofol alone.     

应用自控镇静术拔除阻生牙的临床研究

目的:评价自控镇静术在拔除阻生牙中的应用价值。方法:22例患者的双侧阻生下颌第三磨牙,分别在单纯局麻(L组)或自控镇静术联合局麻(PCS组)下拔除,观察两种麻醉的镇静效果和对呼吸循环的影响。结果:¹PCS 组和L组患者血压、心律稳定;两组患者脉搏氧饱和度均维持在97%以上,镇静评分小于或等于3分(Ramsy评分)。 ºPCS组术中和术后患者满意度、手术医师满意度都明显比L组高(P<0105)。结论:自控镇静术能提供安全有效的拔牙术中镇静,是一种具有应用价值的术中镇静方法。     

A sedation technique for implant and periodontal surgery

OBJECTIVE: Evaluation of a sedation technique which involved titrating intravenous midazolam to an 'ideal' sedation end point, followed by a continuous infusion of propofol. This technique might be a satisfactory alternative to general anaesthesia for implant surgery in anxious patients or when procedures exceed 60-min duration. MATERIAL AND METHODS: 20 patients were treated on 23 occasions. A 2-mg bolus of midazolam was injected intravenously followed after 90 s by 1 mg increments until the patient was adequately sedated. 30 min after this induction with midazolam, a propofol infusion was started at a rate which varied between 0-300 mg/h (0-30 ml/h). The actual infusion rate was adjusted in order to maintain the optimum sedation level which had been achieved using midazolam. The quality of sedation was assessed using Ellis and Sedation scores. RESULTS: Midazolam dosage varied between 5 and 14 mg. The initial propofol infusion rate was 200 mg/h (20 ml/h) for 21 of the 23 implant surgery treatments. CONCLUSION: The sedation technique described takes advantage of the differing pharmacokinetic properties of midazolam and propofol. Initial sedation was achieved using midazolam, this was then maintained using a variable propofol infusion. The shorter distribution and elimination half-lifes of the latter drug made matching the level of sedation to the patient's needs easier and also provided good short-term recovery.     

Comparison of remifentanil with fentanyl for deep sedation in oral surgery.

PURPOSE: The aim of this study was to compare recovery for oral surgery patients given a deep sedation regimen of midazolam, propofol, and remifentanil with a standard control of fentanyl in place of remifentanil. MATERIALS AND METHODS: This investigation was designed as a randomized, prospective, single-blinded controlled study. Group 1, the control, received midazolam 0.03 mg/kg, fentanyl 1 microg/kg, and propofol initially at 140 microg/kg/min. Group 2 received midazolam 0.03 mg/kg, remifentanil: propofol (1:500) given at an initial propofol infusion rate of 40 microg/kg/min. Outcome measures included time to response to verbal command, Aldrete score = 9, Postanesthesia Discharge Scoring System = 7, and assessment by the Digit Symbol Substitution Test. RESULTS: Forty-seven subjects were entered in the study. Baseline findings were homogenous between the 2 groups. Subjects in group 2 recovered earlier (P < .005) and required less propofol for both the induction (0.8 +/- 0.4 versus 1.2 +/- 0.6 mg/kg; mean +/- SD, P < .01) and maintenance of deep sedation (46 +/- 9 versus 131 +/- 17 microg/kg/min; P < .005). There were minor differences in vital signs. CONCLUSIONS: This study demonstrated that this remifentanil regimen provided significantly more rapid recovery and used significantly less propofol compared with the fentanyl regimen.     

BIS monitoring during midazolam and midazolam-ketamine conscious intravenous sedation for oral surgery

OBJECTIVE: The purpose of this study was to determine whether the bispectral index scale (BIS) would provide added benefit to established methods of monitoring conscious sedation with midazolam (M group) or midazolam supplemented with ketamine (MK group). STUDY DESIGN: BIS was prospectively and blindly examined in 22 patients receiving outpatient oral surgery with conscious sedation supplemented with local anesthesia. RESULTS: The average midazolam dose in the midazolam group over the treatment period was 0.01 mg/kg/h, and the average midazolam plus ketamine dose was 0.01 and 0.05 mg/kg/h, respectively. Mean BIS values throughout the sedation study period were 90 for the midazolam group and 94 for the midazolam plus ketamine group. The addition of ketamine did not lower BIS. BIS values did not alter significantly over time except for an expected transient drop after the midazolam bolus induction. CONCLUSION: BIS levels remained close to baseline levels, suggesting that BIS would not provided any additional benefit to currently established methods of monitoring patient consciousness during conscious sedation for oral surgery.     

Intravenous sedation in pediatric dentistry using midazolam, nalbuphine and droperidol

PURPOSE: The purpose of this pilot investigation was to study the efficacy, physiologic responses, and safety of a multi-drug intravenous conscious sedation technique in an outpatient setting in children who demonstrated uncooperative behavior when comprehensive restorative dental treatment was attempted. METHODS: Using a time-based sedation record, the physiologic responses of 153 healthy children, age range 23 months to 14.5 years, were measured after they had received midazolam (Versed), nalbuphine (Nubain), and droperidol (Inapsine), each administered intravenously, and nitrous oxide and oxygen administered by nasal mask, while each child received comprehensive restorative or surgical dental care. Each patient was monitored according to the American Academy of Pediatrics Sedation Guidelines. Heart rate and rhythm, blood pressure, respiratory rate, hemoglobin oxygen saturation, end-tidal CO2, level of sedation, and behavioral responses were recorded preoperatively, at 5 minute intervals during treatment and in recovery until discharge. Sedation was titrated to Level 2 or 3 during treatment as defined by the American Academy of Pediatric Dentistry Reference Manual. RESULTS: For each child, the sedation level was judged to be either acceptable or optimal for the completion of all planned dental treatment. There were no sedation failures. Children under 20 kg required significantly higher dosages of each sedative medication than children more than 20 kg to achieve the same level of sedation (P < 0.001, ANOVA). There were no episodes of intraoperative vomiting, hypotension, cardiac arrhythmias, respiratory depression requiring respiratory support, or dysphoria during treatment, in the recovery period, or after discharge. CONCLUSION: This multi-drug intravenous conscious sedation technique is a safe and effective method to control the behavior of uncooperative children who require comprehensive dental treatment.     

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.     

A study of anxiety, and midazolam-induced amnesia in patients having lower third molar teeth extracted

We studied 60 patients to find out whether anxiety affects the dose of midazolam necessary for sedation, and whether operating time, dose of midazolam, or technique have any influence on levels of amnesia and anxiety. A pilot study preceded the main study in which 20 patients were given local anaesthesia only and 20 local anaesthesia and intravenous sedation. Patients in the main study group (n = 60) received both local anaesthesia and intravenous sedation. The dose required for sedation was not linked to amnesia, pulse rate, blood pressure, or preoperative anxiety. Sedation did significantly reduce postoperative anxiety scores, (P< 0.001) and amnesia was affected by operating time; complete surgical amnesia seemed to last about 25 minutes.     

Efficacy of oral midazolam prior to intravenous sedation for the removal of third molars.

The combination of oral and intravenous sedation has not been well investigated and this study examined the combination's effect on amnesia, anxiety, cardiovascular stability and recovery in a double blind, cross-over, placebo controlled trial. Patients were given 7.5 mg oral midazolam or placebo 1 h prior to intravenous midazolam and surgery. This investigation demonstrated significant anxiolysis, amnesia and patient preference for oral midazolam compared to placebo. There was no significant effect on cardiovascular stability, the intravenous dose of midazolam used or post-operative recovery. Low dose oral midazolam prior to intravenous sedation may be beneficial in very anxious patients, particularly if surgery is delayed.     

Inhaled methoxyflurane (Penthrox) sedation for third molar extraction: a comparison to nitrous oxide sedation

Background: The aim of this study was to evaluate the use of inhaled methoxyflurane (Penthrox^®) in the reduction of dental anxiety in patients undergoing mandibular third molar removal in a specialist surgical suite and compare it to the conventional nitrous oxide sedation. Methods: A prospective randomized, non‐blinded crossover design study of 20 patients receiving two types of sedation for their third molar extraction who participated in 40 treatment sessions. At first appointment, a patient was randomly assigned to receive either nitrous oxide sedation or intermittent Penthrox^® inhaler sedation, with the alternate regimen administered during the second appointment. Peri‐procedural vital signs (heart rate and blood pressure) were recorded and any deviations from 20% from the baseline values, as well as any drop in oxygen saturation below 92% were documented. The Ramsay Sedation Scale (RSS) score was recorded every five minutes. Patient cooperation during the procedure, patients’ general opinion about the sedation technique, surgeon satisfaction and the occurrence of side effects were all recorded. After the second procedure, the patient was also asked if he or she had any preference of one sedation technique over the other. Results: Levels of sedation were comparable in nitrous oxide and Penthrox^® sedation sessions. However, at 15 minutes of sedation it was significantly lighter (p < 0.05) in Penthrox^®. No patient in both regimens reached a RSS deeper than a score of 4. Parameters measured for assessment of sedation (patient cooperation, surgeon satisfaction and patient general opinion about sedation technique) were all similarly comparable for both nitrous oxide and Penthrox^®. In both sedation sessions, the odour of the inhalational agent was accepted by the patients; half of the patients (10 patients) who received methoxyflurane thought its odour was pleasant. Patients preferred methoxyflurane (Penthrox^®) inhalation over nitrous oxide sedation (Fisher’s Exact test, p < 0.05). Adverse events were minimal. No patient was either deeply sedated or agitated. Blood pressure was within ± 20% from the baseline values. No patient had oxygen saturation less than 92%. Dizziness was the most frequently encountered side effect in both regimens (four patients each). Two patients had bradycardia (HR < 60 beats/minute) when nitrous oxide was used in comparison to one patient with Penthrox^® sedation. Paraesthesia of fingers and heaviness of the chest was encountered only with nitrous oxide sedation (four patients). Mild self‐limited shivering occurred in one patient with Penthrox^® sedation. Conclusions: The Penthrox^® Inhaler can produce a comparable sedation to that of nitrous oxide for the surgical extraction of third molars under local anaesthesia.     

Cardiovascular, biochemical, and hormonal responses to intravenous sedation with local analgesia versus general anesthesia in patients undergoing oral surgery

The effects of intravenous conscious sedation and general anesthesia on a number of stress variables were compared in healthy patients undergoing oral surgery. In the intravenous sedation group only the levels of plasma growth hormone and prolactin rose significantly. In the general anesthesia group significant rises were seen in heart rate; systolic blood pressure; mean arterial pressure; levels of plasma adrenaline, adrenocorticotropic hormone, cortisol, and prolactin; and levels of blood glucose, all indicative of a stress response. This study demonstrates that oral surgery under intravenous conscious sedation with local analgesia is associated with less patient stress than is oral surgery under general anesthesia.     

The use of temazepam elixir in surgical dental sedation: a comparison with intravenous midazolam.

Out-patients attending for removal of at least one lower third molar were randomly allocated to treatment with temazepam elixir (n = 7) or intravenous midazolam (n = 8), as well as local analgesia. Patients were tested prior to drug administration and at the end of surgery. Both drugs increased heart rate and midazolam also decreased diastolic blood pressure. The two drugs caused significant, equal increases in ratings of sedation, but the reduction of anxiety was significant only for midazolam. There was significant amnesia for material presented after drug administration, as well as for dental events and this was significantly greater for midazolam. The effects of these drugs in dental patients were compared with those in normal volunteers treated in an identical manner, but without oral surgery. The drugs had similar significant cardiovascular and amnesic effects in the volunteers and the same effects on mood ratings, even though volunteers and patients differed in their pretreatment levels of anxiety and discontent. The dentist's ratings of the sedation and operating conditions were excellent in both cases. Thus temazepam elixir provided a useful sedative for oral surgery, avoiding the complications of intravenous administration. However, for equivalent levels of sedation, midazolam had greater anxiolytic and amnesic effects than temazepam.