Incidence of side effects during i.v. or i.m. midazolam sedation in children and young people with disabilities. Two-year experience

Abstract

Introduction: It is difficult to perform dental treatment and diagnostic examinations in non-cooperative patients with neuro-motor disorders. At Teletón Institute in Santiago, Chile, these procedures are performed while the patient is under sedation, administered by non-anesthesiologist health professionals. Midazolam is used for mild or moderate sedation (level II to IV, Ramsay scale), guided by a specific protocol. Side effects and adverse drug reactions in patients with neuro-motor disabilities are scarcely documented for the last 10 years. Objective: To establish the incidence of side effects after the administration of intravenous or intramuscular Midazolam in non-cooperative patients with neuromotor disorders, requiring sedation in order to receive dental treatment and other procedures such as visual evoked potentials (VEP), brain-stem evoked response audiometry (BERA) and for the preparation of custom made trunk and limb orthoses. Materials and Methods: Drug surveillance study, based on 389 sedation records of the nurses’ unit at Teleton Institute in Santiago, Chile during 2014 and 2015. The following variables were recorded: route of administration, procedure, adverse drug reaction, and type of reaction. Results: Of 389 sedation procedures, 255 (65.5%) were for dental treatment; 83% were administered intravenously; 10 adverse drug reaction events (2.6%) were recorded: paradoxical reactions (6), low blood pressure (3), tachycardia (1) and 60% oxygen desaturation (1). Conclusion: Isolated use of midazolam, in compliance with administration and surveillance protocols, is a safe alternative for mild to moderate sedation, administered by non-anesthesiologist health professionals, showing minimum adverse effects.