IV Sedation Complications — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsIV Sedation ComplicationsORE Part 1

During intravenous midazolam conscious sedation for dental treatment, which is the most commonly reported minor adverse effect?

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Correct answer: B — Paradoxical excitement

Explanation lettering: E = shown as D · D = shown as E

The best answer is B. In the directly relevant review of IV midazolam used for dental procedures, paradoxical reaction/excitement was the most commonly reported minor adverse effect; it occurred in 6.5% of randomised-trial participants. Transient oxygen desaturation (A) and respiratory depression are clinically important recognised complications, so UK practice requires careful titration and respiratory monitoring, but they were not the most commonly reported minor event in that dental evidence. Anaphylaxis (C) is very rare. Midazolam deliberately produces dose-related anterograde amnesia, but amnesia persisting for weeks (D) is not the expected adverse effect. Loss of consciousness requiring intubation (E) represents unintended deep sedation or a major airway complication, not a usual minor adverse effect.

Reference: Ashley PF, Williams CECS, Moles DR, Parry J. Reported side effects of intravenous midazolam sedation when used in paediatric dentistry: a review. International Journal of Paediatric Dentistry, 2015. https://pubmed.ncbi.nlm.nih.gov/25131504/