Use of Midazolam Intranasal Spray for Dental Treatment of Autism Patients

자폐증 환자의 행동조절을 위한 Midazolam Intranasal Spray 사용사례

  • Song, Young-Gyun (Department of advanced General Dentistry, Dental Hospital, Dankook University) ;
  • Lee, Suk Young (Department of Anesthesiology, Jukjeon Dental Hospital, Dankook University) ;
  • Kim, Seung-Oh (Department of Anesthesiology, School of Dentistry, Dankook University)
  • 송영균 (단국대학교 치과대학 부속치과병원 통합진료과) ;
  • 이숙영 (단국대학교 치과대학 죽전치과병원 치과마취과) ;
  • 김승오 (단국대학교 치과대학 치과마취과)
  • Received : 2012.09.19
  • Accepted : 2012.12.14
  • Published : 2012.12.31

Abstract

Autism patients in general have bad oral hygiene. It is hard for autism patients to get dental treatment as poor communication. Therefore, they may have to be treated by deep sedation or general anesthesia in numerous cases. However, this process requires induction with mask, so it is not easy to do for disobliging autism patient. Midazolam is a water-soluble benzodiazepine, has been used in pediatric dentistry or dentistry for the handicapped because of rapid onset. Midazolam can be administered through oral, rectal, intramuscular,intravenous, and intranasal (IN) routes. IN route of midazolam may be considered as effective way to allay for uncooperative autism patients before general anesthesia. In this case report, two autism patients required dental treatment. Intranasal spray of midazolam before general anesthesia was safe and effective procedure of behavioral management.

Keywords

References

  1. Sreebny LM, Schwartz SS: A reference guide to drugs and drymouth--2nd edition. Gerodontology 1997; 14: 33-47. https://doi.org/10.1111/j.1741-2358.1997.00033.x
  2. Tesini DA, Fenton SJ: Oral health needs of persons with physical or mental disabilities. Dental clinics of North America 1994; 38: 483-98.
  3. Kanner L: Autistic disturbances of affective contact. Acta paedopsychiatrica 1968; 35: 100-36.
  4. Friedlander AH, Yagiela JA, Paterno VI, Mahler ME: The neuropathology, medical management and dental implications of autism. J Am Dent Assoc 2006; 137: 1517-27. https://doi.org/10.14219/jada.archive.2006.0086
  5. Higgins M: Dental anesthesiology--an access to care issue. The Alpha omegan 2006; 99: 56-63. https://doi.org/10.1016/j.aodf.2006.06.005
  6. Feld LH, Negus JB, White PF: Oral midazolam preanesthetic medication in pediatric outpatients. Anesthesiology 1990; 73: 831-4. https://doi.org/10.1097/00000542-199011000-00006
  7. Smith BM, Cutilli BJ, Saunders W: Oral midazolam: pediatric conscious sedation. Compend Contin Educ Dent 1998; 19: 586-88, 590, 592.
  8. Kupietzky A, Houpt MI. Midazolam: a review of its use for conscious sedation of children. Pediatric dentistry 1993; 15: 237-41.
  9. Hartgraves PM, Primosch RE: An evaluation of oral and nasal midazolam for pediatric dental sedation. ASDC journal of dentistry for children 1994; 61: 175-81.
  10. Hussain AA: Mechanism of nasal absorption of drugs. Progress in clinical and biological research 1989; 292: 261-72.