Intranasal spray for pediatric sedation

Dr. Primosch is professor and Dr.Guelmann is associate professor, Department of Pediatric Dentistry, University of Florida, Gainesville, Fla. Correspond with Dr. Primosch at [email protected] Abstract Purpose: The purpose of this retrospective record review of 2and 3-year-old dental patients receiving intranasal midazolam (INM) was to compare drops vs spray administration to behavioral outcomes observed for agent acceptance during administration and for agent efficacy during parental separation, local anesthesia injection, and delivery of restorative dentistry. Methods: Temperament and attachment scores based on adaptability and approachability determinants judged by the parent and interactive and Frankl behavior rating scores determined by the operator were used to compare preoperative behavioral characteristics between the 2 groups. The Ohio State Behavioral Rating Scale (OSBRS) and the Frankl behavior rating scale were used to determine intraoperative behavioral outcomes for agent acceptance and efficacy. Results: Analysis of 64 sedation records revealed that the 2 groups had similar preoperative behavioral characteristics. Improvements in the Frankl behavioral rating scores were observed during the sedation, but no statistically significant difference between the drops and spray groups was measured using the OSBRS. For the procedural event of drug administration, however, the spray group demonstrated a statistically significant reduction (P=.025) in aversive behaviors when compared to drops administration as measured by the OSBRS. This finding was observed, even though the volume of spray was greater than used in the drops group. Conclusions: Spray administration of INM produced significantly less aversive behavior than administering drops in 2to 3-year-old dental patients of similar behavioral characteristics. The effectiveness of the conscious sedation technique was not influenced by the method of nasal administration. This study suggested that the use of a commercially available atomizer improved patient acceptance of INM administration but did not influence agent efficacy compared to drops administration for 2to 3-year-old dental patients in an office setting. (Pediatr Dent 2005;27:401-408)