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Musani I, Bhure S, Choubey S, Musani SI, Surve S. Intranasal Midazolam Premedication for Anxiolysis in Children Reluctant to Receive Nitrous Oxide Sedation via Nasal Hood: An In Vivo Randomized Control Trial. Int J Clin Pediatr Dent 2022; 14:S138-S142. [PMID: 35645485 PMCID: PMC9108801 DOI: 10.5005/jp-journals-10005-2092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim and objective The aim of the study was to compare administration of 0.1 mg/kg intranasal midazolam as premedication against a normal saline control in alleviating anxiety relating to and increasing acceptance of nasal hood by child patients receiving nitrous oxide sedation. Materials and methods After ethical clearance and informed consent, on the basis of odd and even numbers patients were allocated to group midazolam (group M) or group normal saline (group N), respectively. The physical parameters were recorded at the beginning and after the procedure; time required for the procedure was also recorded. The level of cooperation during acceptance of the nasal mask by the patient was evaluated using the four-point scale. Result Group M (midazolam premedication) was more effective in improving the acceptance of the nasal hood in children than the normal saline/traditional/conventional method of treating the teeth. The p -value is .002308. Conclusion In the present study the combination of midazolam and nitrous oxide proved to be an effective combination, resulting in good to excellent behavior in children who were Frankl's behavior rating definitely negative and negative. Clinical significance For successful sedation premedication with nitrous oxide, midazolam is an excellent premedication drug. How to cite this article Musani I, Bhure S, Choubey S, et al. Intranasal Midazolam Premedication for Anxiolysis in Children Reluctant to Receive Nitrous Oxide Sedation via Nasal Hood: An In Vivo Randomized Control Trial. Int J Clin Pediatr Dent 2021;14(S-2):S138-S142.
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Affiliation(s)
- Iqbal Musani
- Department of Pediatric Dentistry, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
| | - Sabina Bhure
- Private Practitioner, Pediatric Dentistry, Bhiwandi, Maharashtra, India
| | - Shikha Choubey
- Department of Pediatric Dentistry, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
- Shikha Choubey, Department of Pediatric Dentistry, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India, Phone: +91 9827248806, e-mail:
| | - Smita Iqbal Musani
- Department of Prosthodontics, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
| | - Safa Surve
- Department of Pediatric Dentistry, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
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Srinivasan NK, Karunagaran P, Panchal V, Subramanian EMG. Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2022; 14:S111-S116. [PMID: 35645472 PMCID: PMC9108794 DOI: 10.5005/jp-journals-10005-2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Pradeep Karunagaran
- Department of Anesthesiology, Saveetha Medical College, Chennai, Tamil Nadu, India
| | - Veerale Panchal
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India
- Veerale Panchal, Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India, Phone: +91 9967518954, e-mail:
| | - EMG Subramanian
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India
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Preethy NA, Somasundaram S. Sedative and Behavioral Effects of Intranasal Midazolam in Comparison with Other Administrative Routes in Children Undergoing Dental Treatment - A Systematic Review. Contemp Clin Dent 2021; 12:105-120. [PMID: 34220149 PMCID: PMC8237818 DOI: 10.4103/ccd.ccd_470_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/11/2020] [Accepted: 11/02/2020] [Indexed: 11/05/2022] Open
Abstract
AIM The aim of this study was to systematically identify and evaluate the available literature on the effectiveness of intranasal midazolam sedation compared with midazolam administered through other routes in the sedation and behavior management of children during dental treatment. MATERIALS AND METHODS The search was done using electronic databases such as PubMed Central, Cochrane Database of Systematic Reviews, LILACS, ScienceDirect, and SIGLE. All studies comparing the sedative effect and behavior management effectiveness of intranasal midazolam with midazolam administered through other routes in children were included. RESULTS Electronic database search identified 163 articles, out of which 143 were excluded after reading titles and removing duplication. The remaining 20 studies were evaluated in detail. A final of 13 studies were included based on the inclusion criteria. Among the 13 studies included in the present review, a high risk of bias was noted in all the 13 articles. There was no adequate blinding of personnel and participants in the study, allocation concealment was improper and presence of inadequate blinding of the outcome assessment. . Statistically, no significant difference was observed between intranasal midazolam and other midazolam routes on behavior and sedation level in the studies included in this review. CONCLUSION Limited studies are available pertaining to the sedative and behavioral effects of intranasal midazolam, and thus, this review recommends need for more research evaluating the sedative effect of intranasal midazolam in comparison with midazolam administered through other routes in the behavior management of children during dental treatment.
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Affiliation(s)
- Neethu Ann Preethy
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha University, Chennai, Tamil Nadu, India
| | - Sujatha Somasundaram
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha University, Chennai, Tamil Nadu, India
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Mostafa MG, Morsy KM. Premedication with intranasal dexmedetomidine, midazolam and ketamine for children undergoing bone marrow biopsy and aspirate. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2012.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mostafa G. Mostafa
- Department of Anesthesia, ICU and Pain Management, Asyut University, Asyut, Egypt
| | - Khaled M. Morsy
- Department of Anesthesia, ICU and Pain Management, Asyut University, Asyut, Egypt
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Kunusoth R, Tej G, Ealla KKR, Kathuroju PK, Ayyagari A, Alwala AM. Comparative Analysis of Intravenous Midazolam with Nasal Spray for Conscious Sedation in Minor Oral and Maxillofacial Surgeries. J Pharm Bioallied Sci 2019; 11:S42-S50. [PMID: 30923430 PMCID: PMC6398308 DOI: 10.4103/jpbs.jpbs_199_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aim: The aim of the current study was to evaluate the efficacy of nasal spray midazolam by collating it with conventional intravenous midazolam for conscious sedation in minor oral surgeries. Materials and Methods: Sixty patients were selected randomly and divided into two groups: group A for intranasal midazolam atomized spray (n = 30) and group B for intravenous midazolam (n = 30). Physiological parameters, anxiety score, sedation rating, patient’s cooperation score, and retrograde and anterograde amnesia were recorded for each patient during preoperative, intraoperative, and postoperative period. Final evaluation of safety and efficacy in the nasal and intravenous routes of midazolam drug during minor oral surgery was compared. Results: In this study, both intranasal and intravenous groups showed decrease in systolic blood pressure and diastolic blood pressure intraoperatively but within physiological limits and increase in the average pulse rates in both the groups. The average oxygen saturation levels were maintained to normal range in both the groups. The average respiratory rate decreased in both intranasal and intravenous groups during surgical procedure. The preoperative to postoperative anxiety scores were decreased significantly in the both groups and there was no significant difference in pre- to postoperative anxiety scores between the groups. Conclusion: Both intravenous and intranasal administration of midazolam showed better patient cooperation, satisfaction, and clinical effectiveness. Intranasal midazolam spray is effective in the reduction of subjective stress, reliable anxiolysis while preserving protective reflexes.
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Affiliation(s)
- Ramesh Kunusoth
- Department of Oral and Maxillofacial Surgery, MNR Dental College and Hospital, Sangareddy, Hyderabad, Telangana, India
| | - Gururam Tej
- Department of Periodontology, MNR Dental College and Hospital, Sangareddy, Hyderabad, Telangana, India
| | - Kranti Kiran Reddy Ealla
- Department of Oral and Maxillofacial Pathology, MNR Dental College and Hospital, Sangareddy, Hyderabad, Telangana, India
| | - Pavan Kumar Kathuroju
- Department of Prosthodontics, MNR Dental College and Hospital, Sangareddy, Hyderabad, Telangana, India
| | - Anusha Ayyagari
- Department of Oral and Maxillofacial Surgery, MNR Dental College and Hospital, Sangareddy, Hyderabad, Telangana, India
| | - Aditya Mohan Alwala
- Department of Oral and Maxillofacial Surgery, MNR Dental College and Hospital, Sangareddy, Hyderabad, Telangana, India
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Abstract
BACKGROUND Children's fear about dental treatment may lead to behaviour management problems for the dentist, which can be a barrier to the successful dental treatment of children. Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. There is a need to determine from published research which agents, dosages and regimens are effective. This is the second update of the Cochrane Review first published in 2005 and previously updated in 2012. OBJECTIVES To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 22 February 2018); MEDLINE Ovid (1946 to 22 February 2018); and Embase Ovid (1980 to 22 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in children up to 16 years of age. We excluded cross-over trials. DATA COLLECTION AND ANALYSIS Two review authors independently extracted, in duplicate, information regarding methods, participants, interventions, outcome measures and results. Where information in trial reports was unclear or incomplete authors of trials were contacted. Trials were assessed for risk of bias. Cochrane statistical guidelines were followed. MAIN RESULTS We included 50 studies with a total of 3704 participants. Forty studies (81%) were at high risk of bias, nine (18%) were at unclear risk of bias, with just one assessed as at low risk of bias. There were 34 different sedatives used with or without inhalational nitrous oxide. Dosages, mode of administration and time of administration varied widely. Studies were grouped into placebo-controlled, dosage and head-to-head comparisons. Meta-analysis of the available data for the primary outcome (behaviour) was possible for studies investigating oral midazolam versus placebo only. There is moderate-certainty evidence from six small clinically heterogeneous studies at high or unclear risk of bias, that the use of oral midazolam in doses between 0.25 mg/kg to 1 mg/kg is associated with more co-operative behaviour compared to placebo; standardized mean difference (SMD) favoured midazolam (SMD 1.96, 95% confidence interval (CI) 1.59 to 2.33, P < 0.0001, I2 = 90%; 6 studies; 202 participants). It was not possible to draw conclusions regarding the secondary outcomes due to inconsistent or inadequate reporting or both. AUTHORS' CONCLUSIONS There is some moderate-certainty evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment. There is a need for further well-designed and well-reported clinical trials to evaluate other potential sedation agents. Further recommendations for future research are described and it is suggested that future trials evaluate experimental regimens in comparison with oral midazolam or inhaled nitrous oxide.
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Affiliation(s)
- Paul F Ashley
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Grays Inn RoadLondonUKWC1X 8LD
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Musani IE, Chandan NV. A comparison of the sedative effect of oral versus nasal midazolam combined with nitrous oxide in uncooperative children. Eur Arch Paediatr Dent 2015; 16:417-24. [PMID: 25939638 DOI: 10.1007/s40368-015-0187-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
AIM To compare a combination of oral midazolam (0.2 mg/kg body weight) and nitrous oxide-oxygen sedation with a combination of intranasal midazolam (0.1 mg/kg body weight) and nitrous oxide-oxygen sedation for effectiveness, patient acceptability and safety profile in controlling the behaviour of uncooperative children. METHODS Thirty children, 4-10 years of age, referred for dental treatment were included in the study with a crossover design. Each patient was sedated with a combination of either oral midazolam and nitrous oxide-oxygen sedation or intranasal midazolam and nitrous oxide-oxygen sedation at subsequent dental treatment visits. During the treatment procedure, the study recorded scales for drug acceptability, onset of sedation, acceptance of nasal mask, sedation, behavioural, safety, overall behaviour and alertness. RESULTS The grade of acceptability of midazolam in both groups was consistently good. There was a significant difference (p < 0.001) in the time of onset of sedation, which was significantly quicker with the intranasal administration of midazolam. The mean time of onset for oral midazolam was 20.1 (17-25) min and for intranasal midazolam 12.1 (8-18) min. The efficacy profile of the present study included: acceptance of nasal mask, sedation score, crying levels, motor movements and overall behaviour scores. The results did not show any statistically significant differences. All the parameters were highly satisfactory. The difference in alertness was statistically significant (p value <0.05), being higher in the intranasal group than the oral group and suggestive of faster recovery using intranasal midazolam. CONCLUSION The intranasal route of midazolam administration has a quick onset of action and a quick recovery of the patient from sedation as compared to the oral route of midazolam administration. Midazolam administered through the intranasal route is as effective as the oral route at a lower dosage. Therefore, it is an effective alternative to oral route for a paediatric dental situation.
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Affiliation(s)
- I E Musani
- Department of Pediatric and Preventive Dentistry, M.A. Rangoonwala Dental College and Research Centre, Pune, 2390-B, K.B. Hidayatullah Road, Azam Campus, Camp, Pune, 411001, Maharashtra, India
| | - N V Chandan
- Department of Pediatric and Preventive Dentistry, M.A. Rangoonwala Dental College and Research Centre, Pune, 2390-B, K.B. Hidayatullah Road, Azam Campus, Camp, Pune, 411001, Maharashtra, India.
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Mathai A, Nazareth M, Raju RS. Preanesthetic sedation of preschool children: Comparison of intranasal midazolam versus oral promethazine. Anesth Essays Res 2015; 5:67-71. [PMID: 25885303 PMCID: PMC4173384 DOI: 10.4103/0259-1162.84197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Ensuring adequate preoperative sedation and anxiolysis is essential, especially in pediatric surgery. Various drugs and routes of administration have been evaluated to determine the optimal method of sedation. Materials and Methods: We selected hundred preschool children undergoing elective surgery and sedated them with either intranasal midazolam or oral promethazine syrup in the preoperative period. They were assessed with respect to their levels of sedation till the period of mask placement for induction of general anesthesia. Results: Both groups had comparable heart rates, respiratory rates, sedation scores, and emotional scores at all points of assessment (P>0.05). However, intranasal midazolam had a significantly shorter onset of sedation as well as time to reach maximal sedation (P<0.001). Conclusion: We conclude that either drug may be used with ease in preschool children undergoing elective surgery.
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Affiliation(s)
- Ashu Mathai
- Department of Anesthesiology, Christian Medical College, Ludhiana, Punjab, India
| | - Marilynn Nazareth
- Department of Anesthesiology, Goa Medical College, Bambolim, Goa, India
| | - Rinu Susan Raju
- Department of Anesthesiology, Christian Medical College, Ludhiana, Punjab, India
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Chokshi AA, Patel VR, Chauhan PR, Patel DJ, Chadha IA, Ramani MN. Evaluation of intranasal Midazolam spray as a sedative in pediatric patients for radiological imaging procedures. Anesth Essays Res 2015; 7:189-93. [PMID: 25885831 PMCID: PMC4173518 DOI: 10.4103/0259-1162.118954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Preoperative anxiety and uncooperativeness experienced by pediatric patients are commonly associated with postoperative behavioral problems. AIMS We aimed to evaluate the efficacy and safety of intranasal Midazolam as a sedative in a pediatric age group for radiological imaging procedures and to note onset of sedation, level of sedation, condition of patient during separation from parents and effect on the cardio-respiratory system. SETTINGS AND DESIGN Randomized double-blinded study. SUBJECTS AND METHODS Fifty patients of the pediatric age group of American Society of Anesthesiologist grade 2 and 3 who came for any radiological imaging procedures were studied. Patients were randomly allocated to receive, intranasally, either Midazolam 0.5 mg/kg (group A N = 25) or normal saline (group B N = 25) in both nostrils (0.25 mg/kg in each) 15 min before the procedure. Time for onset of sedation and satisfactory sedation, sedation score, separation score, hemodynamic changes and side-effects were recorded. STATISTICAL ANALYSIS USED Student's t-test. RESULTS Intranasal Midazolam group had a significantly shorter time for onset of sedation and satisfactory sedation. Mean sedation score and mean separation score at 10 min and 15 min intervals were significant in intranasal Midazolam as compared with normal saline (P < 0.001). CONCLUSIONS Intranasal Midazolam 0.5 mg/kg is safe and effective and provides adequate sedation for easy separation from the parents and reduced requirement of intravenous supplementation during radiological imaging procedures without any untoward side-effects.
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Affiliation(s)
- Anisha A Chokshi
- Department of Anaesthesiology, B.J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Vipul R Patel
- Department of Anaesthesiology, B.J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Parthiv R Chauhan
- Department of Anaesthesiology, B.J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Deep J Patel
- Department of Anaesthesiology, B.J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Indu A Chadha
- Department of Anaesthesiology, B.J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Monal N Ramani
- Department of Anaesthesiology, B.J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
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Abstract
BACKGROUND Children's fear about dental treatment may lead to behaviour management problems for the dentist, which can be a barrier to the successful dental treatment of children. Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. There is a need to determine from published research which agents, dosages and regimens are effective. OBJECTIVES To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry. SEARCH METHODS Electronic searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Dissertation Abstracts, SIGLE, the World Wide Web (Google) and the Community of Science Database were conducted for relevant trials and references up to 4th August 2011. Reference lists from relevant articles were scanned and the authors contacted to identify trials and obtain additional information. There were no language restrictions. Trials pre-1966 were not searched. SELECTION CRITERIA Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in children up to 16 years of age. Crossover trials were excluded. DATA COLLECTION AND ANALYSIS Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Where information in trial reports was unclear or incomplete authors of trials were contacted. Trials were assessed for risk of bias. The Cochrane Collaboration statistical guidelines were followed. MAIN RESULTS Thirty-six studies were included with a total of 2810 participants. Thirty trials (83%) were at high risk of bias and six (17%) were at unclear risk of bias. There were 28 different sedatives used with or without inhalational nitrous oxide. Dosages, mode of administration and time of administration varied widely. Trials were grouped into placebo-controlled, dosage and head-to-head comparisons. Meta-analysis of the available data was possible for studies investigating oral midazolam vs placebo only. There is weak evidence from five small clinically heterogeneous trials at high risk of bias, that the use of oral midazolam in doses between 0.25 mg/kg to 0.75 mg/kg is associated with more co-operative behaviour compared to placebo; standardised mean difference (SMD) favoured midazolam (SMD 2.98, 95% confidence interval (CI) 1.58 to 4.37, P < 0.001, I² = 91%), which translates to an increase of approximately 1.8 points on the six-point Houpt behaviour scale. There is very weak evidence from two trials which could not be pooled that inhalational nitrous oxide is more effective than placebo. AUTHORS' CONCLUSIONS There is some weak evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment. There is very weak evidence that nitrous oxide inhalation may also be effective. There is a need for further well designed and well reported clinical trials to evaluate other potential sedation agents. Further recommendations for future research are described and it is suggested that future trials evaluate experimental regimens in comparison with oral midazolam or inhaled nitrous oxide.
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