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Oral Sedation: A Primer on Anxiolysis for the Adult Patient
Mark DonaldsonBScPhm, RPh, PharmD,
Gino GizzarelliBScPhm, DDS, MSc, and
Brian ChanpongDDS, 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

tolerate minor dental treatment but have a higher level of anxiety for more involved treatment. For example, they may tolerate hygiene appointments, but may not be willing to accept other, more invasive treatments, such as a crown preparation or a root canal treatment. Patients with a moderate to high level of fear and anxiety are more likely to miss, cancel, or avoid a dental appointment. 2 7 10 13 19 21 22 The majority of these fearful patients can be easily and safely treated with oral sedatives (see Table ). Adults, in general, have few objections to taking

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Figure 9.; Comparison of practitioners' preference for oral sedative agents.
William G. Flick,
Alexander Katsnelson, and
Howard Alstrom
Figure 9.
Figure 9.

Comparison of practitioners' preference for oral sedative agents.

Remimazolam: The Next Evolutionary Step for Sedative-Hypnotics
Kyle J. KramerDDS, 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

Figure 2.; Sublingual administration on a mannequin. While the teeth were brushed, the tip of the toothbrush was set sublingually, and a sedative was injected.
Jun Hirokawa and
Naomi Kimata
Figure 2.
Figure 2.

Sublingual administration on a mannequin.

While the teeth were brushed, the tip of the toothbrush was set sublingually, and a sedative was injected.

Figure 2.  ; Flowchart of enrollment, allocation, and data analysis. 1 Change to another sedative because of not following preoperative fasting period; 2 intravenous (IV) access failure (twice; n = 1); 3 IV access failure (twice; n = 1) and trouble with heart rate variability (HRV) measurement equipment (n = 2).
Keiichiro Wakana,
Yukifumi Kimura,
Yukie Nitta, and
Toshiaki Fujisawa
<bold>Figure 2. </bold>
Figure 2. 

Flowchart of enrollment, allocation, and data analysis. 1 Change to another sedative because of not following preoperative fasting period; 2 intravenous (IV) access failure (twice; n = 1); 3 IV access failure (twice; n = 1) and trouble with heart rate variability (HRV) measurement equipment (n = 2).

Figure 2. ; Regression and correlation analysis between the mean infusion rate of propofol and frequency (total number of cases, only propofol, propofol, and other sedative drugs). A significant positive correlation was observed between the frequency of intravenous sedation and the dosage of propofol. A tendency for a slower increase in propofol dosage was seen when combined with other drugs such as midazolam ± butorphanol, as the slope of the regression line is decreased.
Yoshihiro Nakaike,
Hikaru Sato,
Rina Sato,
Hikaru Moriyama,
Shota Abe,
Kenji Yoshida,
Hiroyoshi Kawaai, and
Shinya Yamazaki
<bold>Figure 2.</bold>
Figure 2.

Regression and correlation analysis between the mean infusion rate of propofol and frequency (total number of cases, only propofol, propofol, and other sedative drugs). A significant positive correlation was observed between the frequency of intravenous sedation and the dosage of propofol. A tendency for a slower increase in propofol dosage was seen when combined with other drugs such as midazolam ± butorphanol, as the slope of the regression line is decreased.

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.

Figure 1.; Radial graph of mean scores in all cases of 3 groups. Plotted markers indicate mean score values of all cases in each group. High scores are revealed for clenching in groups A2 and R, and for head or extremity movements in group R. One case in the A1 group was judged ineffective as the patient could not be awaked by calling her name or shaking her shoulders for about 1 hour after the injection. Other cases in group A1 almost achieved a satisfactory sedative condition. In group A2, a higher dose was necessary for control of jaw movements, but it made airway maintenance more difficult. In the R group, the score related to the airway was zero in all cases. Although the patients of this group were administered a higher dose of flunitrazepam than the other groups, the dose was not enough for control of resistant behavior.
Figure 1.
Figure 1.

Radial graph of mean scores in all cases of 3 groups.

Plotted markers indicate mean score values of all cases in each group. High scores are revealed for clenching in groups A2 and R, and for head or extremity movements in group R. One case in the A1 group was judged ineffective as the patient could not be awaked by calling her name or shaking her shoulders for about 1 hour after the injection. Other cases in group A1 almost achieved a satisfactory sedative condition. In group A2, a higher dose was necessary for control of jaw movements, but it made airway maintenance more difficult. In the R group, the score related to the airway was zero in all cases. Although the patients of this group were administered a higher dose of flunitrazepam than the other groups, the dose was not enough for control of resistant behavior.

Pharmacokinetic Considerations for Moderate and Deep Sedation
Daniel E. BeckerDDS
Article Category: Research Article
Volume/Issue: Volume 58: Issue 4
Online Publication Date: Jan 01, 2011
DOI: 10.2344/0003-3006-58.4.166
Page Range: 166 – 173

individuals and clinical situations. Most sedative agents can calm and sedate patients adequately, provided a sufficient concentration is achieved within the targeted neural tissues. An understanding of the challenge of achieving an effective but safe drug concentration in the brain rests on an appreciation of fundamental principles of pharmacokinetics. Pharmacodynamic issues, drug actions and effects, will be the topic of a subsequent continuing education article. Pharmacokinetic processes include drug absorption, biotransformation (metabolism), distribution, and