{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:52:57Z","timestamp":1787025177558,"version":"build-2736575974"},"reference-count":11,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023]]},"abstract":"Premedication is often used to reduce the stress associated with anesthesia-related procedures. However, in some cases, patients may not cooperate with medication delivery because of significant fear and anxiety. We report a case of an uncooperative patient with severe intellectual disabilities who was successfully premedicated with the unique technique of sublingual midazolam administration using a suction toothbrush. The 38-year-old male patient was planned to receive dental treatment under deep intravenous sedation (IVS), but he refused both intravenous cannulation and mask induction. Preanesthetic medication delivery using other routes was attempted but not accepted. As the patient tolerated toothbrushing, we used repeated practice with sublingual water administration through the toothbrush's suction hole to gradually desensitize the patient. Using that same method, sublingual midazolam was administered as a successful premedication to allow placement of a face mask for inhalational induction without distress and completion of the dental treatment under IVS. For patients who refuse other premedication routes, sublingual administration during toothbrushing with a suction toothbrush may provide a successful alternative.<\/jats:p>","DOI":"10.2344\/anpr-70-01-05","type":"journal-article","created":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T10:57:13Z","timestamp":1687949833000},"page":"80-84","source":"Crossref","is-referenced-by-count":2,"title":["Successful Premedication With Sublingual Midazolam Using a Suction Toothbrush"],"prefix":"10.2344","volume":"70","author":[{"given":"Jun","family":"Hirokawa","sequence":"first","affiliation":[{"name":"Miyazaki Dental Welfare Center, Miyazaki City Dental Association, Miyazaki, Miyazaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Kimata","sequence":"additional","affiliation":[{"name":"Miyazaki Dental Welfare Center, Miyazaki City Dental Association, Miyazaki, Miyazaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","reference":[{"issue":"(2)","key":"i1878-7177-70-2-80-b01","series-title":"Spec Care Dentist","first-page":"88","article-title":"Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs","volume":"18","author":"Sharon","year":"1998","unstructured":"Sharon\n MG,\n \n \n Raymond\n AD,\n \n \n James\n S.\n \n \n Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs.\n\t\t\t\t\tSpec Care Dentist.\n\t\t\t\t\t1998;\n\t\t\t\t\t18(2):\n\t\t\t\t\t88\u2013\n\t\t\t\t\t92."},{"key":"i1878-7177-70-2-80-b02","series-title":"Acta Anaesthesiol Taiwan","first-page":"134","article-title":"Anesthetic premedication: new horizons of an old practice","volume":"52","author":"Michael","year":"2014","unstructured":"Michael\n JS,\n \n \n Fang-Lin\n C,\n \n \n Shung-Tai\n H.\n \n \n Anesthetic premedication: new horizons of an old practice.\n\t\t\t\t\tActa Anaesthesiol Taiwan.\n\t\t\t\t\t2014;\n\t\t\t\t\t52:\n\t\t\t\t\t134\u2013\n\t\t\t\t\t142."},{"key":"i1878-7177-70-2-80-b03","series-title":"Anesthesiology","first-page":"676","article-title":"Midazolam effects on amnesia and anxiety in children","volume":"93","author":"Zeev","year":"2000","unstructured":"Zeev\n NK,\n \n \n Maura\n BH,\n \n \n Linda\n CM,\n \n et al.\n \n Midazolam effects on amnesia and anxiety in children.\n\t\t\t\t\tAnesthesiology.\n\t\t\t\t\t2000;\n\t\t\t\t\t93:\n\t\t\t\t\t676\u2013\n\t\t\t\t\t684."},{"key":"i1878-7177-70-2-80-b04","series-title":"Paediatr Anaesth","first-page":"685","article-title":"Premedication with midazolam in young children: a comparison of four routes of administration","volume":"12","author":"Alexander","year":"2002","unstructured":"Alexander\n K,\n \n \n Jacob\n K,\n \n \n Rachel\n E,\n \n \n Leonid\n AE.\n \n \n Premedication with midazolam in young children: a comparison of four routes of administration.\n\t\t\t\t\tPaediatr Anaesth.\n\t\t\t\t\t2002;\n\t\t\t\t\t12:\n\t\t\t\t\t685\u2013\n\t\t\t\t\t689."},{"issue":"(1)","key":"i1878-7177-70-2-80-b05","series-title":"Anaesthesia","first-page":"21","article-title":"Intramuscular midazolam premedication in small children","volume":"41","author":"Taylor","year":"1986","unstructured":"Taylor\n MB,\n \n \n Vine\n PR,\n \n \n Hatch\n DJ.\n \n \n Intramuscular midazolam premedication in small children.\n\t\t\t\t\tAnaesthesia.\n\t\t\t\t\t1986;\n\t\t\t\t\t41(1):\n\t\t\t\t\t21\u2013\n\t\t\t\t\t26."},{"issue":"(1)","key":"i1878-7177-70-2-80-b06","series-title":"Br J Anaesth","first-page":"69","article-title":"Drug absorption by sublingual and rectal routes","volume":"56","author":"Boer","year":"1984","unstructured":"Boer\n AGD,\n \n \n Leede\n LGD,\n \n \n Breimer\n DD.\n \n \n Drug absorption by sublingual and rectal routes.\n\t\t\t\t\tBr J Anaesth.\n\t\t\t\t\t1984;\n\t\t\t\t\t56(1):\n\t\t\t\t\t69\u2013\n\t\t\t\t\t82."},{"issue":"(5)","key":"i1878-7177-70-2-80-b07","series-title":"Clin Pharmacol Ther","first-page":"491","article-title":"Oral first-pass elimination of midazolam involves both gastrointestinal and hepatic CYP3A-mediated metabolism","volume":"59","author":"Thummel","year":"1996","unstructured":"Thummel\n KE,\n \n \n O'Shea\n D,\n \n \n Paine\n MF,\n \n et al.\n \n Oral first-pass elimination of midazolam involves both gastrointestinal and hepatic CYP3A-mediated metabolism.\n\t\t\t\t\tClin Pharmacol Ther.\n\t\t\t\t\t1996;\n\t\t\t\t\t59(5):\n\t\t\t\t\t491\u2013\n\t\t\t\t\t502."},{"issue":"(2)","key":"i1878-7177-70-2-80-b08","series-title":"Paediatr Anaesth","first-page":"103","article-title":"Comparison between three transmucosal routes of administration of midazolam in children","volume":"7","author":"Geldner","year":"1997","unstructured":"Geldner\n G,\n \n \n Hubmann\n M,\n \n \n Knoll\n R,\n \n \n Jacobi\n K.\n \n \n Comparison between three transmucosal routes of administration of midazolam in children.\n\t\t\t\t\tPaediatr Anaesth.\n\t\t\t\t\t1997;\n\t\t\t\t\t7(2):\n\t\t\t\t\t103\u2013\n\t\t\t\t\t109."},{"issue":"(10)","key":"i1878-7177-70-2-80-b09","series-title":"Masui","first-page":"1227","article-title":"A comparative study of sublingual midazolam with oral midazolam for premedication in pediatric anesthesia. Article in Japanese","volume":"57","author":"Kattoh","year":"2008","unstructured":"Kattoh\n T,\n \n \n Katome\n K,\n \n \n Makino\n S,\n \n \n Wakamatsu\n N,\n \n \n Toriumi\n S.\n \n \n A comparative study of sublingual midazolam with oral midazolam for premedication in pediatric anesthesia. Article in Japanese.\n\t\t\t\t\tMasui.\n\t\t\t\t\t2008;\n\t\t\t\t\t57(10):\n\t\t\t\t\t1227\u2013\n\t\t\t\t\t1232."},{"issue":"(3)","key":"i1878-7177-70-2-80-b10","series-title":"J Pharmacobiodyn","first-page":"206","article-title":"Relative bioavailability of midazolam following sublingual versus oral administration in healthy volunteers","volume":"11","author":"Fujii","year":"1988","unstructured":"Fujii\n J,\n \n \n Inotsume\n N,\n \n \n Nakano\n M.\n \n \n Relative bioavailability of midazolam following sublingual versus oral administration in healthy volunteers.\n\t\t\t\t\tJ Pharmacobiodyn.\n\t\t\t\t\t1988;\n\t\t\t\t\t11(3):\n\t\t\t\t\t206\u2013\n\t\t\t\t\t209."},{"key":"i1878-7177-70-2-80-b11","series-title":"J Med Assoc Thai","first-page":"S45","article-title":"A comparison of oral chloral hydrate and sublingual midazolam sedation for echocardiogram in children","volume":"91","author":"Thanarat","year":"2008","unstructured":"Thanarat\n L,\n \n \n Chaisit\n S,\n \n \n Thawatchai\n K,\n \n et al.\n \n A comparison of oral chloral hydrate and sublingual midazolam sedation for echocardiogram in children.\n\t\t\t\t\tJ Med Assoc Thai.\n\t\t\t\t\t2008;\n\t\t\t\t\t91:\n\t\t\t\t\tS45\u2013\n\t\t\t\t\tS52."}],"container-title":["Anesthesia Progress"],"original-title":[],"link":[{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/70\/2\/article-p80.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/meridian.allenpress.com\/anesthesia-progress\/article-pdf\/70\/2\/80\/3230239\/i1878-7177-70-2-80.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/70\/2\/article-p80.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/70\/2\/article-p80.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T08:44:20Z","timestamp":1728290660000},"score":1,"resource":{"primary":{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/70\/2\/article-p80.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023]]},"references-count":11,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.2344\/anpr-70-01-05","relation":{},"ISSN":["1878-7177","0003-3006"],"issn-type":[{"value":"1878-7177","type":"electronic"},{"value":"0003-3006","type":"print"}],"subject":[],"published":{"date-parts":[[2023]]}}}