The effects of temperament and behaviour problems on sedation failure in anxious children after midazolam premedication.

BACKGROUND AND OBJECTIVE: Midazolam is one of the most frequently used agents for sedation in paediatric dentistry. It is unclear how temperament traits and behaviour problems are related to sedation failure in children. We investigated whether sedation failure after premedication with oral midazolam can be predicted by behaviour problems and temperament traits.

METHODS: Sixty children (aged 4-8 years) referred for dental treatment under sedation (40/60% N2O/O2), who had a Frankl Behaviour Scale score of at least 3, were premedicated with oral midazolam (0.75 mg kg(-1)). The level of sedation was assessed at defined time intervals, according to the Houpt Sedation Rating Scale. Children's sedation success during dental treatment was classified as satisfactory or unsatisfactory. Heart rate and oxygen saturation were evaluated by an oxygen saturation monitor in the sedation period. On the treatment day, parents completed 'The Revised Conners' Parent Rating Scale' and 'Short Temperament Scale for Children' to assess their child's behaviour problems and temperament, respectively.

RESULTS: The rates of sedation success were found to be satisfactory in 78.4% and unsatisfactory in 21.6%. Student's t-test demonstrated that in addition to the Short Temperament Scale for Children Inflexibility subscale being significant the Revised Conners' Parent Rating Scale: Long Form Psychosomatic subscale was also found to be a significant predictor of sedation failure.

CONCLUSION: Psychosomatic behaviour problems and an inflexible temperament trait might contribute to sedation failure in children undergoing dental treatment under midazolam premedication and N2O/O2 sedation. Appropriate patient selection based on the evaluation of childhood behavioural problems and temperament characteristics might increase midazolam sedation success in children.