Improved sedation for oral surgery by combining nitrous oxide and intravenous midazolam: a randomized, controlled trial

The objective is to investigate whether sedation techniques for oral surgery can be improved by combining the use of inhalation of nitrous oxide/oxygen with intravenous Midazolam. Prospective, randomized controlled clinical trial: Patients requiring extractions or surgery were randomly allocated to subgroups receiving either intravenous Midazolam or nitrous oxide/oxygen or a combined technique using nitrous oxide/oxygen and intravenous Midazolam. Safety parameters, amount of sedative agents administered, recovery time and co-operation scores were recorded. Patients receiving the combined sedation technique were initially titrated with 10% nitrous oxide, increasing by increments of 10% up to a maximum of 40% nitrous oxide and 60% oxygen. Midazolam was then titrated (initially 2 mg wait 2 min with increments of I mg every minute until appropriately sedated) whilst still administering 40% nitrous oxide. When a combined technique of N2O/O-2 and Midazolam was used there was a statistically significant reduction in the amount of Midazolam required to achieve effective sedation (P < 0.001), an overall significant reduction in recovery time (P < 0.001) and a significant improvement in co-operation (P < 0.01) and arterial oxygen saturation (P < 0.001). This combined technique was found to be safe and reliable, requiring reduced doses of Midazolam and demonstrable improvement in patient recovery and cooperation.