Lam Christy, Udin Richard D, Malamed Stanley F, Good David L, Forrest Jane L
Advanced Pediatric Dentistry Program, University of Southern California School of Dentistry, 925 W 34th St, Los Angeles, CA 90089-0641, USA.
Anesth Prog. 2005 Summer;52(2):56-61. doi: 10.2344/0003-3006(2005)52[56:MPICAP]2.0.CO;2.
The purpose of this study was to compare the effectiveness of intramuscular and intranasal midazolam used as a premedication before intravenous conscious sedation. Twenty-three children who were scheduled to receive dental treatment under intravenous sedation participated. The patients ranged in age from 2 to 9 years (mean age, 5.13 years) and were randomly assigned to receive a dose of 0.2 mg/kg of midazolam premedication via either intramuscular or intranasal administration. All patients received 50% nitrous oxide and 50% oxygen inhalation sedation and local anesthetic (0.2 mL of 4% prilocaine hydrochloride) before venipuncture. The sedation level, movement, and crying were evaluated at the following time points: 10 minutes after drug administration and at the times of parental separation, passive papoose board restraint, nitrous oxide nasal hood placement, local anesthetic administration, and initial venipuncture attempt. Mean ratings for the behavioral parameters of sedation level, degree of movement, and degree of crying were consistently higher but not significant in the intramuscular midazolam group at all 6 assessment points. Intramuscular midazolam was found to be statistically more effective in providing a better sedation level and less movement at the time of venipuncture than intranasal administration. Our findings indicate a tendency for intramuscular midazolam to be more effective as a premedication before intravenous sedation.
本研究的目的是比较肌内注射和鼻内注射咪达唑仑作为静脉清醒镇静前用药的有效性。23名计划接受静脉镇静下牙科治疗的儿童参与了研究。患者年龄在2至9岁之间（平均年龄5.13岁），随机分配接受0.2mg/kg剂量的咪达唑仑，通过肌内注射或鼻内给药进行术前用药。所有患者在静脉穿刺前均接受50%氧化亚氮和50%氧气吸入镇静以及局部麻醉（0.2mL 4%盐酸丙胺卡因）。在以下时间点评估镇静水平、活动情况和哭闹情况：给药后10分钟以及父母分离、被动使用束身板约束、放置氧化亚氮鼻罩、局部麻醉给药和首次静脉穿刺尝试时。在所有6个评估点，肌内注射咪达唑仑组的镇静水平、活动程度和哭闹程度等行为参数的平均评分始终较高，但无统计学意义。结果发现，与鼻内给药相比，肌内注射咪达唑仑在静脉穿刺时能提供更好的镇静水平且活动更少，具有统计学意义。我们的研究结果表明，肌内注射咪达唑仑作为静脉镇静前的术前用药更有效。
