436 - Effectiveness of Nitrous Oxide Prior to Intranasal Midazolam Administration

Background: In pediatric dental moderate sedations, intranasal midazolam can cause a burning sensation. Concurrent nitrous oxide (N2O) can mitigate this. The study investigates effective post-midazolam nitrous oxide concentrations (50% N2O/50% O2 or 30% N2O/70% O2). Side effects can occur above 50% N2O. There is opportunity to determine the incidence of adverse events during administration of 50% N2O/50% O2 and 30% N2O/70% O2.

Purpose: This research aims to discern differences in heart rate post-intranasal midazolam between a 50% N2O/50% O2 group and a 30% N2O/70% O2 group. It evaluates the effectiveness of 50% N2O/50% O2 versus 30% N2O/70% O2 in reducing pain perception. The study also seeks to identify adverse events associated with both nitrous oxide concentrations.

Methods: Conducted as a randomized controlled trial, the study enrolls ASA I or II pediatric patients aged 3-8 for dental procedures requiring moderate sedation. Blinded assignments are made to either a 50% N2O/50% O2 group or a 30% N2O/70% O2 group. Measurements include pre- and post-intranasal midazolam administration heart rate and blood pressure. Pain perception is assessed using the Wong-Baker pain scale, a visual analog scale (VAS), and input from parents/guardians and the dental provider. Statistical analyses involve Welch’s t-test and variance measures.

Results: Six participants (ages 3-5) were enrolled, with four in the intervention group and two in the control group. No statistically significant difference between the two groups was detected.

Conclusions: Patients and parents indicated low pain and fear scores pre-operatively. Parent assessments of child behavior is significant, while provider’s is not. More data is needed to determine significance of heart rate changes and the beneficial effects of nitrous before midazolam administration.
Significance: This study aims to optimize intranasal Versed administration by tailoring nitrous oxide concentrations for enhanced patient comfort and minimized side effects.