Retrospective Comparisons of the Efficacy and Safety of Variable dosing of Midazolam with and without Meperidine for Management of Varying Levels of Anxiety of Pediatric Dental Patients: 35 years of Sedation Experience

Abstract

Purpose: This retrospective study compares the efficacy and safety of variable dosing of Midazolam (Mid) with and without Meperidine (Mep) combinations for managing varying levels of anxiety and uncooperative behavior of young pediatric dental patients over a thirty-five-year period. Study design: Reviews of the sedation logs of 1,785 sedation visits are compared with emphasis on what dosing proves both safe and effective for differing levels of challenging pediatric behavior. Variable dosing of midazolam with and without meperidine which spanned low-end, mid-range, and upper-end were judged making use of a pragmatic approach which defined sedation success as optimal, adequate, inadequate, or over-dosage. Behavioral and physiologic assessment was included with attention to readily observable analysis of the extent to which need for physical restraint occurred to control interfering behavior. Assessment of arousal levels requiring stimulation along with the frequency of alterations in oxygen de-saturation and adverse reactions were included as indications of safety. Results: Where Mep was used, success rates were consistently higher; working times were significantly prolonged and greater control was provided to avoid adverse reactions by virtue of reversal capability for both agents. Conclusions: Predictability and working time of Midazolam was enhanced by combination with narcotic for all levels of patient anxiety. Dosages of 0.7–1.0 mg/kg Mid combined with 1.0–1.5 mg/kg Mep offers the most effective and safe results to overcome need for restraint for moderate and severe levels of anxiety, respectively.