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There is potential risk of an allergic reaction with latex and all drugs including muscle relaxants, antibiotics, local anesthetics, induction drugs, and opioids administered during anesthesia. 1 , 2 Although midazolam is considered a relatively safe drug, it has been reported that midazolam may cause a life-threatening anaphylactoid reaction and hypersensitivity, such as hypotension, edema, and bronchoconstriction, during anesthesia. 3 – 9 We obtained the patient's consent for publication of protected health information of this case

behavior while offering a wide margin of safety. 4 Benzodiazepines have become a favored class of drugs for oral pediatric dental sedation because of relative safety at therapeutic doses. 5 Benzodiazepines have the favorable effects of being amnestic, hypnotic, sedative, and anticonvulsant. Importantly, benzodiazepines can be reversed with flumazenil. However, as intravenous access is not generally provided by pediatric dentists, off-label intramuscular injection would be needed, and the proper dosage and time to reversal is not yet clear. Midazolam has an onset time

(nitrous oxide/oxygen), is used to achieve moderate levels of sedation during dental procedures. 3 Midazolam is one of the most used medications for enteral sedation in the pediatric dental field. However, its working time is limited, and it notably lacks any analgesic properties. 4 The addition of opioids such as meperidine has been used to overcome these deficiencies. 5 Recently, the use of meperidine has diminished due to its active metabolite, normeperidine, and negative side effects such as altered mental status, nervousness, myoclonus, seizures, delirium, and

time is of the essence. A technique that is gaining popularity for patients who cannot cooperate with IV cannulation is intranasal midazolam (INM). 3 INM delivered via a mucosal atomizer device (MAD) is rapidly absorbed through the nasal mucosa into the systemic circulation. 3 One major advantage of INS is the fact that it has duration of onset that is 3 times faster than that of OS. 2 This is due to the rapid absorption of the drug, which bypasses first-pass hepatic portal metabolism. 2 There is also a reduced risk of the child spitting out the

Midazolam has been frequently used for intravenous sedation in dental treatment because of reliable sedation and profound amnesia. Propofol has been applied not only for general anesthesia but also for intravenous sedation by using the bolus or continuous injection technique. It has been reported that the paradox phenomenon, represented by instances of hostility, rage, and physical violence, can be caused by midazolam 1–7 and that delirium is induced by propofol. 8 9 We report 2 episodes of delirium caused by midazolam alone and by

intravenous conscious sedation is the intended level of sedation. Intravenous sedation is often administered to anxious patients in dental practice. For these patients, fear and anxiety about pain on injection of sedation medication may have a great impact on such patients. We believe that erasing the negative memory of the painful injection of propofol is therefore important. Ideally, sedation providers would like to either predict the susceptibility to propofol injection pain or prevent it completely. Midazolam has a great advantage in eliminating

and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely . 3(p639) Drugs that can be used include inhalational agents such as nitrous oxide and orally or parenterally administered midazolam and other benzodiazepines, other sedative-hypnotics, and psychosedative agents. Nitrous oxide and oral, intravenous, and intranasal midazolam are commonly used agents. 4 Individual use of these agents has been reported to have benefits; however, a combination of

intubated patients. Since then its clinical application has expanded to include neurosurgery, pediatric procedural sedation, awake fiber-optic intubation, cardiac surgery, bariatric surgery, and dental procedures. 5 , 8 – 14 Its use as a single agent during dental procedures under intravenous sedation has been reported in several studies. Dexmedetomidine has been shown to be comparable to or better than midazolam as a single agent in third-molar extractions 15 , 16 ; however, it does not produce consistent amnestic effects. 16 More recently, a case report described the

Dental treatment often involves uncomfortable procedures that require adequate sedation. Intravenous midazolam and propofol have long been used to induce appropriate sedation during dental treatment. In particular, propofol is used in patients with a severe gag reflex. 1 , 2 Midazolam is a fast-acting benzodiazepine with a short elimination half-life. It exhibits sedative, anxiolytic, hypnotic, and anterograde amnesic properties. 3 In addition, flumazenil, a benzodiazepine antagonist, can be used to treat a midazolam overdose. Propofol was