Midazolam use for dental conscious sedation: how safe are we?

Aim: To explore the safety awareness of midazolam use amongst dentist in the UK. Materials and methods: A cross-sectional study on 203 dentists was undertaken, 146 of whom currently practice conscious sedation using intravenous midazolam. Use of high strength midazolam; awareness of the Rapid Response Report (RRR) and the National Reporting and Learning System (NRLS); and midazolam related incidents were explored. Results: Formal training in conscious sedation was variable with 35.6% holding a postgraduate sedation qualification. Flumazenil administration was common practice (63%) although used very selectively. Use to reverse respiratory depression was minimal (4%). Awareness of the RRR and the NRLS was generally low but higher among those working in general dental practice (p\ensuremath<0.05). Comparative analysis showed that high dose midazolam was administered more frequently in gastroenterology than in dentistry (p\ensuremath<0.001) with higher incidences of overdose (12.4% Vs 4.8%) and death (8.3% Vs 0%) within a 3 year period. Conclusions: High strength midazolam administration remains prevalent in dentistry, despite recommendations by the DoH. Use of flumazenil for reasons other than respiratory depression in dentistry should warrant little concern. The low incidence of reported harm is positive but may be due to a lack of uptake of national reporting systems.