Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Gerodontology. 2022 Jun;39(2):161-169. doi: 10.1111/ger.12550. Epub 2021 Mar 21.
To describe the efficacy and safety of intranasal midazolam for sedation during essential dental treatment of geriatric patients with major neurocognitive disorder (MND) and care-resistant behaviour (CRB).
Dental treatment is often impossible in geriatric MND patients with CRB. Intranasal midazolam may provide a non-invasive sedation method, but there is currently no information on its use in geriatric patients.
In this observational study, we included geriatric patients with severe MND and CRB needing urgent dental treatment. Each patient received 5 mg midazolam intranasally. Agitation/sedation levels, heart rate, respiration rate and oxygen saturation were recorded at 5-minute intervals.
Thirty two patients were included. Mean age was 84 (±7) years. Mean (SD) time to treatment start was 13 (±5) minutes, and mean time to maximum sedation 17 (±11) minutes. Sedation was sufficient to enable dental treatment to be completed in 31 (97%) patients. Anxiolysis/light sedation occurred in 16 (50%) patients, and moderate to deep sedation occurred in 16 (50%) patients. No patients suffered from apnoea, although 3 patients required a chin-lift manoeuvre. Hypoxaemia occurred in 1 of these patients and in 2 other patients without airway obstruction. All patients recovered uneventfully. In a regression model, age, weight and other sedative medication use were found not to be associated with maximum sedation depth.
Of 5 mg intranasal midazolam facilitates treatment of geriatric patients with MND in the comfort of their own environment. More information is needed to guide titration to balance the desired sedation level and patient safety.
描述经鼻给予咪达唑仑在患有严重神经认知障碍（MND）和行为抗拒（CRB）的老年患者进行基本牙科治疗时的镇静效果和安全性。
牙科治疗在有 CRB 的老年 MND 患者中往往是不可能的。经鼻给予咪达唑仑可能提供一种非侵入性的镇静方法，但目前尚无关于其在老年患者中应用的信息。
在这项观察性研究中，我们纳入了需要紧急牙科治疗的严重 MND 和 CRB 的老年患者。每位患者接受 5mg 咪达唑仑经鼻给药。每隔 5 分钟记录一次激惹/镇静水平、心率、呼吸频率和血氧饱和度。
共纳入 32 例患者。平均年龄为 84（±7）岁。从治疗开始到治疗开始的平均时间为 13（±5）分钟，从开始到最大镇静的平均时间为 17（±11）分钟。镇静足以使 31 例（97%）患者的牙科治疗完成。16 例（50%）患者出现焦虑/轻度镇静，16 例（50%）患者出现中度至深度镇静。没有患者出现呼吸暂停，但 3 例患者需要进行下颌抬起手法。在这些患者中的 1 例和在另外 2 例无气道阻塞的患者中出现了低氧血症。所有患者均恢复顺利。在回归模型中，年龄、体重和其他镇静药物的使用与最大镇静深度无关。
5mg 经鼻给予咪达唑仑有助于在老年 MND 患者舒适的环境中进行治疗。需要更多的信息来指导滴定，以平衡所需的镇静水平和患者的安全性。
