Midazolam in Pediatric Dentistry 2024

“Sedation” caught our imagination very early in our career in Pediatric Dentistry. We realized that we were duty bound to provide anxious children, with high-quality pain-free treatment even when their age and cognition did not allow them to cooperate for demanding dental procedures. Inhalation sedation with nitrous oxide and oxygen helped us fulfill this objective more often than not. But yet, we learnt in the steep learning curve of procedural sedation that a small group of children cannot comprehend the nasal hood and require other modes to help them through. We worked with various drugs like chloral hydrate, hydroxyzine, midazolam, dexmedetomidine, etc., only to find inconsistent success. Experience gradually taught us that understanding the limitations of these drugs was as important as understanding their indications and advantages. We also learnt that success with sedation should not come at the cost of unintentional deep sedation or the associated risks. As we worked more with midazolam with an understanding of its limitations, this drug started revealing its magic in terms of producing reliable, consistent, and safe anxiolysis, sedation, and amnesia along with a host of other advantages. Proper case selection in conjunction with a good local anesthetic technique proved to be the game changers in this journey.