Complications of Intravenous Midazolam–Fentanyl Sedation in Children and Adults Undergoing Oral Surgery: A Retrospective Study

Objective: This study examines the incidence and predictors of complications following intravenous (IV) sedation in children and adults. Methods: A retrospective analysis of 1463 surgical procedures under IV sedation was conducted at the University Hospitals of Leuven (2018–2022). Patients aged 10–91 years were divided into pediatric (10–16 years, n = 731) and adult (17–91 years, n = 732) groups. Data were analyzed using multiple regression models (p < 0.05). Results: Side effects occurred more often during recovery (children: 20.1%, adults: 9.4%) than intraoperatively (children: 4.8%, adults: 2.7%). The most common side effects were nausea (children: 10.5%, adults: 8.4%) and prolonged sedation (children: 6.0%, adults: 1.8%). Younger children had higher risks of intraoperative side effects (p = 0.02), hypotension (p < 0.001), and longer recovery (p < 0.001). Ketamine increased nausea risk in children (p = 0.02). Females had a higher risk of prolonged sedation (p = 0.03) and nausea (p = 0.01). Older adults had fewer recovery-related side effects (p = 0.03) and shorter recovery times (p = 0.05). Conclusions: IV sedation is a safe alternative to general anesthesia in oral surgery when properly monitored. However, nausea and prolonged sedation remain concerns, particularly in younger children and females. Prophylactic anti-emetics and cautious Ketamine use may help mitigate risks.