Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under general anaesthesia

Dental treatment in children who are too young or too apprehensive to cooperate is often performed under sedation. In Sweden, the tradition has been to administer sedatives rectally in small children, but oral liquid sedation is now increasingly used. Aim: To compare the sedative effects of oral and rectal administration of midazolam in children undergoing dental treatment under general anaesthesia and to assess acceptance of sedative administration, acceptance of application of the facemask, and amnesia. Methods: Fifty children aged 2- 7 y were randomly allocated to receive either liquid oral or rectal sedation, with 25 children in each group. Results: The sedative effect of rectal administration was higher, but not statistically significantly, than that of oral administration ( p = 0.07). No significant differences in acceptance of sedative administration, acceptance of mask application or amnesia were found between the groups. Conclusion: Both the oral and the rectal routes can in most cases be appropriate. However, the better sedative effect of rectal administration of midazolam makes it a more favourable route in pre- cooperative and non- compliant children.