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Remimazolam: The Next Evolutionary Step for Sedative-Hypnotics
Kyle J. Kramer DDS, MS
Article Category: Editorial
Volume/Issue: Volume 69: Issue 1
Online Publication Date: Apr 04, 2022
DOI: 10.2344/anpr-69-01-07
Page Range: 1 – 2

and remifentanil. Remimazolam combines virtually all the traditional benefits befitting a classic benzodiazepine, with an extremely rapid onset and favorable emergence profile facilitated by esterase-based metabolism. As a γ-aminobutyric acid type A (GABA a )-positive allosteric modulator, remimazolam is a potent sedative-hypnotic agent producing dose-dependent depression of the central nervous system (CNS), anxiolysis, anterograde amnesia, and anticonvulsant effects. It causes minimal cardiovascular and respiratory depression when judiciously administered alone

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Oral Sedation: A Primer on Anxiolysis for the Adult Patient
Mark Donaldson BScPhm, RPh, PharmD,
 Gino Gizzarelli BScPhm, DDS, MSc, and
 Brian Chanpong DDS, MSc
Article Category: Research Article
Volume/Issue: Volume 54: Issue 3
Online Publication Date: Jan 01, 2007
DOI: 10.2344/0003-3006(2007)54[118:OSAPOA]2.0.CO;2
Page Range: 118 – 129

not without risks. Barbiturates support addictive behavior, can have a variety of unpleasant side effects, and their effectiveness is greatly increased when taken concurrently with other CNS depressants. In fact, barbiturate sleeping pills can quickly cause death when taken with alcohol due to their significant cardiovascular and respiratory depressant effects. It is this narrow margin of safety that prompted the development of safer sedative/hypnotic medications (eg, benzodiazepines) during the next few decades. Due to their unacceptable safety profile, the use of

Figure 1.; Dose-response curve for barbiturates.
Mark Donaldson,
 Gino Gizzarelli, and
 Brian Chanpong
Figure 1.
Figure 1.

Dose-response curve for barbiturates.

Figure 2.; Dose-response curve for benzodiazepines.
Mark Donaldson,
 Gino Gizzarelli, and
 Brian Chanpong
Figure 2.
Figure 2.

Dose-response curve for benzodiazepines.

A Comparison of Fospropofol to Midazolam for Moderate Sedation During Outpatient Dental Procedures
Philip Yen DDS, MS,
 Simon Prior BDS, MS, PhD,
 Cara Riley DMD, MS,
 William Johnston MS, PhD,
 Megann Smiley DMD, MS, and
 Sarat Thikkurissy DDS, MS
Article Category: Other
Volume/Issue: Volume 60: Issue 4
Online Publication Date: Jan 01, 2013
DOI: 10.2344/0003-3006-60.4.162
Page Range: 162 – 177

of a single ideal technique. Additionally, the need and demand for sedation services is on the rise. The search of an ideal sedative agent is centered on the ability to provide amnesia, anxiolysis, and analgesia while providing both practitioner and patient satisfaction. Rapid onset and offset, ease in adjustability, wide margin of safety, and a high-quality procedural sedation are other desirable features. Fospropofol, which is a new sedative/hypnotic agent, is being evaluated for potential benefits compared to existing drugs such as a well-known and widely used

Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients
Christel M. Haberland DDS, MS,
 Suher Baker DMD, BDS, MS, and
 Haibei Liu MPH
Article Category: Research Article
Volume/Issue: Volume 58: Issue 2
Online Publication Date: Jan 01, 2011
DOI: 10.2344/0003-3006-58.2.66
Page Range: 66 – 72

and the amplitude increases. The bispectral index (BIS) monitor (Aspect Medical Systems, Newton, Mass) is an FDA-approved monitor that has been used in clinical practice since 1997. 17 It gathers processed EEG parameters to provide a numeric measure of the hypnotic effect of anesthetic or sedative drugs on brain activity. It is derived from the EEG by a computer algorithm that produces a single numeric value, scaled from 0 to 100. 18 According to the manufacturer, a BIS score of >90 indicates an awake patient; 71–90, mild to moderate sedation; 61–70, deep sedation

Oral Sedation Postdischarge Adverse Events in Pediatric Dental Patients
Annie Huang DMD and
 Thomas Tanbonliong DDS
Article Category: Research Article
Volume/Issue: Volume 62: Issue 3
Online Publication Date: Jan 01, 2015
DOI: 10.2344/0003-3006-62.3.91
Page Range: 91 – 99

combinations of a narcotic (eg, morphine or meperidine), a sedative-hypnotic (eg, chloral hydrate), a benzodiazepine (eg, midazolam or diazepam), and/or an antihistamine (eg, hydroxyzine HCl) ( Figure 1 ) at the following dosages: 0.66 mg/kg for morphine, 2 mg /kg for meperidine, 0.5–0.7 mg/kg for midazolam, 0.5–.7 mg/kg for diazepam, and 2 mg/kg for hydroxyzine HCl. Figure 1. Distribution of oral sedation regimens. Figure 1. Distribution of oral sedation regimens. Following the

Complications After Dental Sedation: A Myotonic Mystery Case Report
Milad Karamlou DDS,
 Iman Asaria DDS,
 Jaime Barron DDS,
 Petra Boutros DMD,
 Vincent Fisher DDS,
 Rachel Grandinetti DMD,
 Julian Johnson DMD,
 Emily Richard DMD,
 David Susko DMD,
 Cristobal Urrutia DDS,
 Bryce Woolsey DDS,
 Ronald Baumann DDS,
 James Cottle DDS,
 Richard Sweaney DDS,
 Mark Wenzel DDS,
 John Nusstein DDS, MS, and
 David Hall DDS
Article Category: Case Report
Volume/Issue: Volume 69: Issue 4
Online Publication Date: Dec 19, 2022
DOI: 10.2344/anpr-69-02-09
Page Range: 26 – 31

Literature Review for Office-Based Anesthesia
All summaries and comments provided by Mark A Saxen DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 67: Issue 1
Online Publication Date: Jan 01, 2020
DOI: 10.2344/0003-3006-67.1.60
Page Range: 60 – 62

;131(5):1004–1017. Dexmedetomidine is a sedative with modest analgesic efficacy, whereas remifentanil is an opioid analgesic with modest sedative efficacy. Synergy is often observed when sedative-hypnotics are combined with opioid analgesics in anesthetic practice. A 3-phase crossover trial was conducted to study the pharmacodynamic interaction between remifentanil and dexmedetomidine. Thirty healthy volunteers, stratified by age and sex, were recruited to undergo target-controlled infusions of dexmedetomidine, remifentanil, and remifentanil with a fixed dexmedetomidine background concentration

Multiple Risks for Patients Using the Transdermal Fentanyl Patch
Joel M. Weaver DDS, PhD, Editor-in-Chief
Article Category: Other
Volume/Issue: Volume 61: Issue 1
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.1.1
Page Range: 1 – 2

steady state, and once it is removed, the residual fentanyl in the skin continues to be absorbed for hours. It takes approximately 17 hours for fentanyl blood levels to drop by 50% once the patch is removed, so fentanyl interactions with sedatives, hypnotics, and other opioids are still possible hours after the patch has been removed. Thus removal of the patch does not quickly eliminate the risk of fentanyl interactions with other drugs. The rate of absorption of the medication can also be influenced by the degree of blood flow through the skin where the patch

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