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Comparison of patient-controlled and operator-controlled conscious sedation for restorative dentistry

  • K. A. Bavisha (a1), M. Elias (a2), S. Paris (a3), A. R. Leon (a4) and P. J. Flynn (a4)...



Background and objective: The use of midazolam for conscious sedation is an accepted method of anxiety control in restorative dentistry. A lack of predictability in its effects requires the dose of midazolam to be adjusted to individual patient's requirements. We determined whether patient-controlled sedation was a suitable alternative to operator-controlled sedation in restorative dentistry.

Methods: A randomized crossover clinical trial involving 35 consecutive patients undergoing similar dental procedures. Patients were randomly given midazolam, administered either by the patient or by the operator at the first visit and the alternative option on the second visit. All patients were ASA I–II and their ages ranged between 20 and 48 yr. Blood pressure, heart rate, oxygen saturation and patient satisfaction were recorded.

Results: The onset time and initial dose for sedation were similar with the two methods of administration and the sedation scores and vital signs were satisfactory. In the patient-controlled group the mean total dose of midazolam was 7.9 (±4.2 SD) mg cf. 4.2 (±1.8 SD) mg in the operator-controlled group (P < 0.05). The time to fitness for discharge (15.4 (± 11.9 SD) min) was greater in the patient-controlled group cf. the operator-controlled group (8.5 (±9.5 SD) min), P < 0.05.

Conclusion: This study shows that patient-controlled sedation is a suitable alternative to operator-controlled sedation in the management of anxious dental patients.


Corresponding author

Correspondence to: K. A. Bavisha, Barts and The London NHS Trust, The Royal London Hospital, New Road, London E1 1BB, UK. E-mail:; Tel: +44 (0)20 7377 7000, ext 2822; Fax: +44 (0)20 7377 7064


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General Dental Council. Maintaining Standards, Guidance to Dentists on Professional and Personal Conduct.London, UK: General Dental Council, Revised November 2001.
A Conscious Decision: Report of an Expert Group. London, UK: Department of Health, July 2000.
Dundee JW, Halliday NJ, Harper KW, Brogden RN. Midazolam: a review of its pharmacological properties and therapeutic use. Drugs 1984; 28: 519543.
Hillestad L, Hansen T, Melsom H, Drivenes A. Diazepam metabolism in normal man. 1. Serum concentrations and clinical effects after intravenous, intramuscular, and oral administration. Clin Pharmacol Ther 1974; 16: 479484.
Corman HH, Hornick EJ, Kritchman M, Terestman N. Emotional reactions of surgical patients to hospitalization, anesthesia and surgery. Am J Surg 1958; 96: 646653.
Sechzer PH. Objective measurement of pain. Anesthesiology 1968; 29: 209210.
Osborne GA, Rudkin GE, Curtis NJ, Vickers D, Craker AJ. Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with anaesthetist-administered midazolam and fentanyl. Anaesthesia 1991; 46: 553556.
Zacharias M, Hunter KM, Luyk NH. Patient-controlled sedation using midazolam. Br J Oral Maxillofac Surg 1994; 32: 168173.
Rodrigo MR, Tong CK. A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery. Anaesthesia 1994; 49: 241244.
Rodrigo C, Chow KC. Patient-controlled sedation: a comparison of sedation prior to and until the end of minor oral surgery. Aust Dent J 1996; 41: 159163.
Poswillo D. General Anaesthesia, Sedation and Resuscitation in Dentistry. Report of an Expert Working Party 1990.Prepared for the Standing Dental Advisory Committee. London, UK: Department of Health.
Dell R. A review of patient-controlled sedation. Eur J Anaesthesiol 1996; 13: 547552.


Comparison of patient-controlled and operator-controlled conscious sedation for restorative dentistry

  • K. A. Bavisha (a1), M. Elias (a2), S. Paris (a3), A. R. Leon (a4) and P. J. Flynn (a4)...


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