Comparison of intravenous sedation using midazolam during dental treatment in elderly patients with/without dementia: a prospective, controlled clinical trial

The effects of intravenous sedation with midazolam on the cerebral function of elderly patients with severe dementia are unclear. This study aimed to evaluate its effects on parameters such as brainwaves and cerebral blood flow (CBF) and compare them between elderly individuals with dementia and without cognitive impairment. Ten patients with severe dementia and 10 without cognitive impairment were registered. The bispectral index (BIS) and normalized tissue hemoglobin index (nTHI), which reflects CBF using near-infrared spectroscopy, were measured. Midazolam was administered until a Modified Observer's Assessment of Alertness/Sedation score of 2 was reached. The chi-squared, Mann-Whitney U, Wilcoxon signed-rank, and Friedman tests and multiple regression analysis were used for comparisons. Whereas a similar decline in BIS values was observed in both groups after midazolam administration (P<0.018), there was a significant decrease by 9% in the nTHI of the dementia-positive group (P<0.013). However, there was no significant difference in the nTHI between the dementia-positive and dementia-negative group according to the multiple regression analysis (P=0.058). In the dementia-negative group, none of the measured values differed from the baseline values. In the dementia-positive group, sedation with midazolam resulted in a 9% decrease in the CBF.

Automated summary

Although both elderly patients with severe dementia and those without cognitive impairment showed a decrease in BIS values after midazolam sedation, the dementia-positive group had a significant 9% decrease in the nTHI, reflecting cerebral blood flow. However, midazolam sedation did not significantly differentiate the nTHI between the dementia-positive and dementia-negative groups. The measured values in the dementia-negative group did not differ from baseline, while sedation with midazolam in the dementia-positive group resulted in a 9% decrease in cerebral blood flow.