Oral midazolam with and without meperidine for management of the difficult young pediatric dental patient: a retrospective study.

PURPOSE: The purpose of this retrospective study was to examine different dosages of midazolam used alone or in combination with different dosages of meperidine for managing difficult young pediatric dental patients. METHODS: Patient records and sedation logs of 120 moderately to severely apprehensive/ uncooperative subjects, ages 24-48 mos, sedated in private practice setting, were reviewed. Subjects, divided into six groups of 20, received midazolam in doses of 0.7 or 1.0 mg/kg with and without meperidine in doses of 1.0 or 1.5 mg/kg. Ratings of the effectiveness of sedation, duration of action, need for restraint to accomplish treatment, and recovery times were made. Nitrous oxide was not used. RESULTS: When used alone, use of 0.7 mg/kg midazolam produced the most agitation, required restraint most frequently, and produced the shortest working time (P<0.001). Subjects receiving 1.0 mg/kg midazolam and meperidine were the most effective, completing 20/20 visits with no need for restraint, no loss of consciousness throughout appointments, and no adverse reactions (P<0.001). Use of lower dose midazolam and higher dose meperidine was reliable, permitting treatment to be completed without restraint in 18/20 patients. Combined higher doses of both agents demonstrated somnolence and oversedation. The addition of meperidine increased working time (P<0.05). CONCLUSIONS: The addition of meperidine appears to enhance the effectiveness and duration of action of midazolam for managing difficult young pediatric patients.