midazolam + hydroxyzine + nitrous oxide + oxygen

The combination of midazolam, hydroxyzine, nitrous oxide, and oxygen is a multi-modal pharmacological sedation regimen primarily utilized in pediatric dentistry to manage uncooperative behavior in children. This regimen leverages the synergistic effects of three distinct sedative agents. Midazolam, a short-acting benzodiazepine, provides anxiolysis and anterograde amnesia by acting as a positive allosteric modulator of the GABA-A receptor. Hydroxyzine, a first-generation antihistamine, contributes supplemental sedation and antiemetic properties through its antagonism of the histamine H1 receptor. Nitrous oxide, an inhaled anesthetic, provides rapid-onset conscious sedation and analgesia, likely through NMDA receptor antagonism and GABA-A receptor modulation. The regimen typically involves oral premedication with midazolam and hydroxyzine followed by the inhalation of a nitrous oxide/oxygen mixture during the dental procedure. Tishreen University has sponsored clinical research evaluating the efficacy of this specific combination compared to oral sedation alone in pediatric patients.

Other names

midazolam + hydroxyzine + nitrous oxide + oxygen