Dexmedetomidine (DEX) has a minimal respiratory depressive effect, which is beneficial for dentistry; however, it has the disadvantage of permitting an intraoperative arousal response such that the patient appears to be suddenly no longer sedated, and it has a variable amnestic effect. Since midazolam (MDZ) in an appropriate dose has a profound amnesic effect, we investigated whether additional MDZ compensates for the disadvantage of DEX and enables a better quality of sedation. Forty-three subjects were randomly divided into 4 groups. In group 1, MDZ (0.02 mg/kg) was administered intravenously, followed by a dose of 0.01 mg/kg every 45 minutes. After the first dose of MDZ, preloading with DEX (2 µg/kg/h for 10 minutes) was started and maintained with a dosage of 0.5 µg/kg/h. In group 2, MDZ was infused in the same manner as in group 1, followed by preloading with DEX (1 µg/kg/h for 10 minutes) and maintenance (0.3 µg/kg/h). In group 3, MDZ was infused 0.03 mg/kg, and a dose of 0.01 mg/kg was given every 30 minutes; DEX was administered at the same as in group 2. In group 4, DEX was infused using the same method as in group 1 without MDZ. The sedation levels, amnesia, and patient satisfaction were also investigated. Group 2 had a lower sedation level and a poor evaluation during the first half of the operation. Group 4 did not exhibit an amnesic effect at the beginning of the operation. An evaluation of the degree of patient satisfaction did not reveal any differences among the groups. Optimal sedation was achieved through the combined use of MDZ (0.02 mg/kg with the addition of 0.01 mg/kg every 45 minutes) and DEX (2 µg/kg/h for 10 minutes followed by 0.5 µg/kg/h).
Wong-Baker FACES Pain Rating Scale.
Effect of dexmedetomidine and midazolam on systemic hemodynamics. Values are measured at the start of sedation (start), lowest during sedation (during), and end of sedation (end). Values represent median (interquartile range [range]). * P < .05. BPs indicates systolic blood pressure; BPd, diastolic blood pressure; HR, heart rate; and SpO2, oxygen saturation.
Effect of dexmedetomidine and midazolam on systemic hemodynamics. Values are measured at the start of sedation (start), lowest during sedation (during), and end of sedation (end). Values represent median (interquartile range [range]). † P < .05 vs start. BPs indicates systolic blood pressure; BPd, diastolic blood pressure; HR, heart rate; and SpO2, oxygen saturation.
The sedation levels in the groups. * P < .05. RSS indicates Ramsay sedation score; G1, group 1; G2, group 2; G3, group 3; and G4, group 4.
The amnesic effect in the groups. * P < .05. G1 indicates group 1; G2, group 2; G3, group 3; and G4, group 4.
Degree of satisfaction using Wong-Baker FACES Pain Rating Scale. There were no significant differences among the groups. G1 indicates group 1; G2, group 2; G3, group 3; and G4, group 4.
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