A study of effectiveness of midazolam sedation for prevention of myocardial arrhythmias in endosseous implant placement

• Published in: Clinical oral implants research Vol. 23; no. 4; pp. 489 - 495
• Main Authors: Romano, Marcelo Munhóes, Soares, Mario Sergio, Pastore, Carlos Alberto, Tornelli, Mauricio José, de Oliveira Guaré, Renata, Adde, Carlos Alberto
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-04-2012
• Subjects: Adult; Anesthesia; Anti-Anxiety Agents - administration & dosage; anxiolytics; arrhythmias; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - prevention & control; Dental Implantation, Endosseous - adverse effects; Dentistry; electrocardiograms; Electrocardiography; Female; Humans; implantology; Male; Midazolam - administration & dosage; Middle Aged; sedation; Statistics, Nonparametric; Treatment Outcome
• ISSN: 0905-7161; 1600-0501
• DOI: 10.1111/j.1600-0501.2011.02171.x

Purpose: The study aimed to assess electrocardiographic alterations during oral implant placement surgeries under local anesthesia (lidocaine chlorhydrate with epinephrine), using 15 mg of midazolam as an anxiolytic premedication.
Material and methods: The study randomly selected 20 patients, aged 21–50 years old, requiring bilateral mandibular dental implants. Each patient was assessed using placebo on one side and midazolam on the contralateral side, with random, double‐blinded distribution. The electrocardiogram recorded 12 static leads every 2 min, while D2 derivations were recorded continuously.
Results: No statistically significant differences were observed between the placebo and midazolam when analyzing the morphological behavior of the electrocardiographic wave and the presence of arrhythmias during the experiment. However, under sedation, assessment of the behavior of electrocardiographic parameters during different stages of the procedure revealed statistically significant differences (P<0.05) for heart rate, P‐wave amplitude and duration of the RR and QTc intervals. The arrhythmias detected were considered low risk for patients without systemic alterations and were observed in 53.3% of patients. The most frequently occurring alterations were tachycardia, bradycardia, supraventricular and ventricular extrasystoles and blocked atrial extrasystole, which were similar for both placebo and midazolam, with the greatest incidence during the initial, incision and bone drilling stages.
Conclusion: The use of 15 mg of midazolam made no difference compared with the placebo. The use of 15 mg of midazolam did not show an advantage in the incidence of arrhythmias The anxiolytic premedication does not prevent myocardial arrhythmias in endosseous implant placement. The clinical significance of the arrhythmias may not represent serious risks.
To cite this article:
Romano MM, Soares MS, Pastore CA, Tornelli MJ, de Oliveira Guaré R, Adde CA. A study of effectiveness of midazolam sedation for prevention of myocardial arrhythmias in endosseous implant placement.
Clin. Oral Impl. Res. 23, 2012 489–495.
doi: 10.1111/j.1600‐0501.2011.02171.x