The effect of midazolam administration for the prevention of emergence agitation in pediatric patients with extreme fear and non-cooperation undergoing dental treatment under sevoflurane anesthesia, a double-blind, randomized study

Background: Sevoflurane is generally the preferred anesthetic agent for general anesthesia in pediatric patients, due to its rapid induction and recovery characteristics. However, it has been recognized that a major complication is emergence agitation when awakening from general anesthesia. The aim of this study was to evaluate the occurrence rate of emergence agitation in the operating room and postoperative recovery area following intraoperative administration of midazolam to pediatric patients under general anesthesia. Patients and methods: One hundred and twenty pediatric patients undergoing dental treatment under sevoflurane anesthesia were enrolled in this study. The patients were divided into three groups (n=40 each in the 0.1 mg/kg midazolam, 0.05 mg/kg midazolam, and control with saline groups). Midazolam or saline was injected intravenously approximately 30 minutes before the end of the dental treatment. We used the Richmond Agitation and Sedation Scale (RASS) to assess the level of sedation and drowsiness at emergence phase in the operating room. We also used the Pediatric Anesthesia Emergence Delirium Scale (PAED) to assess the level of agitation and delirium at the full recovery phase from anesthesia in the recovery area. Results:At the emergence phase, the incidence of emergence agitation in the 0.1 mg/kg midazolam group was significantly lower than in the other groups (p=0.0010). At the recovery phase, there was no significant difference among the three groups. The odds ratio between PAED score and RASS score was 4.0 using logistic regression analysis. The odds ratio between PAED score and Disability was 2.5. Conclusion: Administration of a single dose of 0.1 mg/kg midazolam dose significantly decreases the incidence of severe emergence agitation at the emergence after sevoflurane anesthesia, but not at the recovery phase. Furthermore, the evaluation of sedative and agitation condition using RASS score at emergence from anesthesia is useful to predict occurrence of agitation in the recovery phase

Occlusal force predicts global motion coherence threshold in adolescent boys

Background: Beneficial effects of mastication on cognitive abilities in the elderly have been shown in human studies. However, little is currently known about the effect of masticatory stimulation on cognitive and perceptual ability in younger populations. The purpose of the present study is to investigate the influences of masticatory stimulation on perceptual ability in adolescent boys. Methods: The present study examined the relationship between occlusal force (i.e., masticatory stimulation) and visual perception ability in adolescent boys. Visual perception ability was quantified by measuring global motion coherence threshold using psychophysical method. As an index of masticatory stimulation, occlusal force was measured by pressure sensitive film. We also measured participants\u27 athletic ability, e.g. aerobic capacity and grip strength, as potential confounding factor. Results: The multiple regression analysis revealed a significant negative correlation between global motion coherence threshold and occlusal force, which persisted after controlling for confounding factors such as age and aerobic capacity. Conclusions: This finding indicates that masticatory stimulation enhances visual perception in adolescent boys, indicating the possibility that beneficial effects of masticatory stimulation are observed not only in the elderly but in developing population consistently with the findings of the previous animal studies