OBJECTIVE AND SUBJECTIVE EVALUATIONS TO DETERMINE THE MIDAZOLAM OPTIMAL DOSE IN THE DENTAL TREATMENT

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  • KONDO Keisuke
    Department of Pharmacology, Showa University School of Medicine
  • SAMBE Takehiko
    Department of Pharmacology, Showa University School of Medicine
  • UCHIDA Naoki
    Department of Pharmacology, Showa University School of Medicine
  • IWASE Mariko
    Department of Pharmacology, Showa University School of Medicine
  • NISHIMURA Yuki
    Department of Pharmacology, Showa University School of Medicine
  • MANABE Atsuhumi
    Department of Conservative Dentistry, Division of Aesthetic Dentistry and Clinical Cariology, Showa University School of Dentistry
  • RYU Kakei
    Showa University Clinical Research Institute for Clinical Pharmacology and Therapeutics
  • KOBAYASHI Shinichi
    Showa University Clinical Research Institute for Clinical Pharmacology and Therapeutics
  • INADA Yoko
    Department of Pharmacy Services, Showa University Dental Hospital
  • IKEDA Miyuki
    Department of Pharmacy Services, Showa University Dental Hospital

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Other Title
  • 歯科臨床におけるミダゾラムを用いた至適鎮静用量の客観的・主観的評価
  • シカ リンショウ ニ オケル ミダゾラム オ モチイタ シテキ チンセイ ヨウリョウ ノ キャッカンテキ ・ シュカンテキ ヒョウカ

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Abstract

Dental anesthesia with the intravenous (IV) administration of midazolam (MDZ) has been widely used because of the ease of administration and long-standing clinical experience. However, no detailed reports have investigated the optimal dose necessary to obtain sufficient sedative effects of dental treatment and to avoid the side effects of excessive sedation, such as respiratory depression. This clinical study was conducted to determine the optimal dose of IV MDZ necessary to achieve adequate oral anesthetic effects. We attempted to define the reference index in order to evaluate the most effective clinical anesthetic method in the oral clinical field. The present study was conducted in 10 healthy men. IV MDZ (0.01mg/kg BW) was administered as the first dose. Then, MDZ (0.01mg/kg BW) was administered incrementally until a side effect was elicited or until the accumulated MDZ dose reached 0.1mg/kg BW. For each administration point, oral function, sedative effect, and safety were evaluated. MDZ dose accumulation of over 0.04mg/kg BW reduced the mouth-opening capacity and vomiting reflex. MDZ dose accumulation of over 0.05mg/kg BW reduced the quantity of salivation. Using the VAS level, a peak in the sedative effect occurred at 0.06mg/kg BW. Using the auditory evoked potentials monitor, the epoch showed that optimal sedation increased at 0.03–0.06mg/kg BW. These results suggested that an MDZ dose of 0.06mg/kg BW was suitable for sedation in dental treatment. The results of this investigation can be applied in clinics as an effective index of intravenous sedation.

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