An interesting article titled “Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?” appears in the 2015 Journal of Oral and Maxilofacial Surgery written by Kyle S. Ettinger and et al. (vol. 73, pp. 2287-2293). Midazolam is very commonly used for patients undergoing wisdom teeth surgery and the authors set out to determine if it impacts the length a patient stays in the recovery room.
Intravenous (IV) midazolam has a rapid onset of effect, short duration of action, minimal impact on cardiac function, minimal effect on respiratory depression, and it produces anterograde amnesia. Some more recent literate has shown that IV midazolam might be associated with prolonged recovery time for oral surgery. Midazolam can cause postoperative cognitive impairment. The study used patients who had all four wisdom teeth removed at the Mayo Clinic in Rochester Minnesota between the ages of 14 and 29.
The primary predictor variable for the study was the total dose of IV midazolam administered. The primary outcome variable was the duration of recovery room length of stay (LOS) documented in the electronic anesthesia record. A total of 2,610 patients were eventually included in this retrospective study. The mean dosage of midazolam
administered was 4.1 mg (SD, 1.1 mg; range, 0.5 to 10.0 mg). The mean recovery room LOS for these 2,610 patients was 46 minutes (SD, 19 minutes; range, 11 to 203 minutes). Due to issues with data normality, a few patients with LOS longer than 120 minutes were removed (taken as outliers) and the rest of the 2,597 patients were used in statistical analysis.
The dose of midazolam administered during sedation was not found to be significantly associated with prolonged recovery room LOS in univariable or multivariable settings. Some other results were found though. Covariates found to be statistically signficantly associated with shorter durations of LOS included older age, male gender, and administration of larger perioperative fluid volumes. Patients 20 to 29 years old had LOS durations that were on average 4.7 minutes shorter compared with patients 14 to 16 years old. Men had LOS durations that were on average 1.9 minutes shorter compared with women. Covariates found to be statistically significantly associated with longer durations of LOS included higher American Society of Anesthesiologists (ASA) physical status classification system score, administration of ketamine, and administration of ketorolac.
The authors state:
“The results of this study suggest that in the prototypical patients undergoing IV sedation for outpatient third molar surgery (healthy teenagers and young adults), the dose of midazolam does not significantly impact the duration of recovery room LOS in a clinically meaningful way.”