The use of intranasal midazolam in a special care dentistry department in a hospital setting; technique and cases

Abstract

Intranasally (IN) administered midazolam has allowed patients who require conscious sedation but struggle to tolerate cannulation to receive dental treatment under sedation. Studies have demonstrated a mean bioavailability of 82.4% can be achieved with IN midazolam due to the high vascularity within the nose. These studies have also demonstrated that peak plasma concentrations can be reached within 10 minutes, which signifies the fast onset of action. The standard bolus dose of IN midazolam is 10-12mg, which can be reduced or increased depending on the patient’s age and susceptibility to benzodiazepines. The bolus can also be repeated if adequate sedation is not reached. Some 17 patients received a standard dose of 10mg of midazolam. There were two cases of desaturation below 92%, which responded with oxygen and encouraging the patient to breathe. A protocol for administering IN midazolam is outlined and two cases are discussed.