The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction

Hosey, M. T.; Asbury, A. J.; Bowman, A. W.; Millar, K.; Martin, K.; Musiello, T.; Welbury, R.

doi:10.1038/sj.bdj.2009.570

Cited by 37Dental Anxiety and Anesthesia TechniquesAnesthesia and Sedative AgentsPediatric Pain Management Techniques

The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction

Hosey, M. T., Asbury, A. J., Bowman, A. W., Millar, K., Martin, K., Musiello, T., Welbury, R.·2009·British Dental Journal

DOI 10.1038/sj.bdj.2009.570

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Abstract

Background The project aims were to evaluate the benefit of transmucosal midazolam 0.2 mg/kg pre-medication on anxiety, induction behaviour and psychological morbidity in children undergoing general anaesthesia (GA) extractions.Method One hundred and seventy-nine children aged 5-10 years (mean 6.53 years) participated in this randomised, double blind, placebo-controlled trial. Ninety children had midazolam placed in the buccal pouch. Dental anxiety was recorded preoperatively and 48 hours later using a child reported MCDAS-FIS scale. Behaviour at anaesthetic induction was recorded and psychological morbidity was scored by the parent using the Rutter Scale preoperatively and again one week later. Subsequent dental attendance was recorded at one, three and six months after GA.Results While levels of dental anxiety did not reduce overall, the most anxious patients demonstrated a reduction in anxiety after receiving midazolam premedication (p = 0.01). Neither induction behaviour nor psychological morbidity improved. Irrespective of group, parents reported less hyperactive (p = 0.002) and more pro-social behaviour (p = 0.002) after the procedure; older children improved most (p = 0.048). Post-GA dental attendance was poor and unaffected by premedication.Conclusion 0.2 mg/kg buccal midazolam provided some evidence for reducing anxiety in the most dentally anxious patients. However, induction behaviour, psychological morbidity and subsequent dental attendance were not found to alter.

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The principal investigator (MTH) in a previous RCT in this patient group noted that the personal engagement through frequent contact with study researchers might have had an adverse influence on the study outcome.
“the principal investigator (MTH) in a previous RCT in this patient group noted that the personal engagement through frequent contact with study researchers might have had an adverse influence on the study outcome [28].”
From Improving access to preparatory information for children undergoing general anaesthesia for tooth extraction and their families: Study protocol for a Phase III randomized controlled trial (2014) · cites this paper as [28]
Up to 30% of children referred for dental GA might have undergone a GA previously.
“our previous work has shown that up to 30% of children referred for dental GA might have undergone a GA previously [13,28]”
From Improving access to preparatory information for children undergoing general anaesthesia for tooth extraction and their families: Study protocol for a Phase III randomized controlled trial (2014) · cites this paper as [28]

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Summary of: The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction
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Authors: Hosey, M. T., Asbury, A. J., Bowman, A. W., Millar, K., Martin, K., Musiello, T., & Welbury, R.
Affiliations: King's College London (GB)
Gartnavel General Hospital (GB)
University of Glasgow (GB)
Royal Hospital for Children (GB)
Corresponding author: Hosey, M. T.
ORCID: Hosey, M. T.
Bowman, A. W.
Millar, K.
Welbury, R.
Venue: British Dental Journal
Publisher: Springer Science and Business Media LLC
Published: 2009-07
Volume: 207
Issue: 1
Pages: E2-E2
ISSN: 0007-0610 (ISSN-L)
1476-5373
DOI: 10.1038/sj.bdj.2009.570
OpenAlex: W2001320055
Cited by: 37
References: 34
Citations by year: 2026: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 5 · 2015: 4 · 2014: 6 · 2013: 1 · 2012: 4
FWCI: 2.45
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: BDJ (publishedVersion)
PubMed (publishedVersion)
ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
UWA Profiles and Research Repository (University of Western Australia) (submittedVersion)
CLOK (University of Central Lancashire) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Topics: Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: midazolam, dental anxiety, children, general anesthesia, tooth extraction, anesthesia induction, psychological morbidity, hyperactivity, prosocial behavior
MeSH terms: Administration, Buccal, Anesthesia, Dental, Anesthesia, General, Child, Child Behavior, Child, Preschool, Cooperative Behavior, Dental Care, Dentist-Patient Relations, Double-Blind Method, Emotions, Female, Follow-Up Studies, Humans, Hypnotics and Sedatives, Male, Midazolam, Motor Activity, Placebos, Preanesthetic Medication, Prospective Studies, Psychosocial Deprivation, Social Behavior, Tooth Extraction, Cohort Studies, Dental Anxiety

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The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction

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