Comparing efficacy and safety of four intravenous sedation regimens in dental outpatients

Dionne, Raymond A.; Yagiela, John A.; Moore, Paul A.; Gonty, Arthur A.; Zuniga, John R.; Beirne, O. Ross

doi:10.14219/jada.archive.2001.0271

Cited by 72 publications

(47 citation statements)

References 8 publications

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“…10,11 However, close monitoring of vital signs is essential because these drugs have strong systemic actions on the nervous, respiratory, and circulatory systems. 5,6 The present study identified the safest sedative and patients at the highest risk of experiencing respiratory depression during and delayed recovery after intravenous sedation for dental treatment.…”

Section: Discussionmentioning

confidence: 83%

“…3,4 However, when using intravenous sedative drugs that have strong systemic actions on the central nervous, respiratory, and circulatory systems, systemic management to ensure patient safety is a prerequisite. 5,6 Conscious sedation is generally preferred to maintain independent breathing and biological defense mechanisms such as coughing and swallowing reflexes. However, dental treatment of patients with disabilities may require behavioral control, especially in the case of mentally challenged individuals with strong treatment refusal reactions.…”

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confidence: 99%

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Risk Factors With Intravenous Sedation for Patients With Disabilities

Yoshikawa

Tamaki

Okumura³

et al. 2013

Anesthesia Progress

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The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO 2 ) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO 2 ,90% and a recovery period of .60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO 2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003-7.978; 95% confidence interval; P , .001). Decision tree analysis showed an increased risk of decreased SpO 2 in males with Down syndrome or after administration of .0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered .0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO 2 . In addition, delayed recovery is expected after midazolam administration.

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Section: Discussionmentioning

confidence: 83%

mentioning

confidence: 99%

Risk Factors With Intravenous Sedation for Patients With Disabilities

Yoshikawa

Tamaki

Okumura³

et al. 2013

Anesthesia Progress

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“…(11) , 3. molar diş cerrahisinde midazolam+fentanil grubundaki ağrı ve anksiyete derecelerinin midazolamın tek başına kullanıldığı gruptan daha dü-şük olduğunu bildirmiştir. Milgrom ve ark.…”

Section: Discussionunclassified

Comparing the Effects of Tramadol and Fentanyl on Anxiety and Postoperaıve Pain in Impacted Third Molar Surgery

Göktay¹,

Satilmis²,

Garip³

et al. 2011

J Turk Anaesth Int Care

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ÖZETAmaç: Gömülü 3. molar diş çekimi operasyonu endikasyonu bulunan ve korkan hastalarda anksiyete düzeyini dü-şürmek amacıyla uygulanan sedasyon işlemlerinde midazolam ile kombine edilen fentanil ve tramadolün anksiyete ve postoperatif ağrı üzerine etkisini araştırmaktır.Gereç ve Yöntem: İleriye dönük, randomize, çift kör ve plasebo kontrollü çalışmaya, horizontal gömülü 3. molar diş cerrahi çekimi gerçekleşecek APAIS verileri 10'un üzerinde olan 60 ASA I-II hasta dahil edilmiştir. Hastalar, 0,03 mg kg -1 iv midazolam bolus dozunun uygulanmasını takiben rasgele üç gruba ayrılıp, Grup A'ya yalnızca midazolam, Grup B'ye midazolam ve 1 μg kg -1 fentanil, Grup C'ye midazolam ve tramadol 1 mg kg -1 uygulanmıştır. Tüm vital bulgular, intraoperatif parmak ucu ter indeksi (PSI) verileri kaydedilmiş; hastalar postoperatif ağrı, yan etkiler açısından değer-lendirilmiştir.Bulgular: PSI verilerinde gruplar arası fark saptanmamıştır. Postoperatif ilk 1 saat içinde Grup C'deki VAS değerlerinin diğer iki gruptan anlamlı düzeyde daha düşük olduğu tespit edilmiştir (p<0.05). Gruplar ilk ilaç alım zamanı açısından değerlendirildiğinde A, B, C gruplarının ilk ilaç alım zamanı sırasıyla 3, 3,5, 5 saat olarak tespit edilmiş olup, Grup C'deki hastaların ilk ilaç alım zamanlarının diğer iki gruptan anlamlı şekilde daha uzun olduğu saptanmıştır (p<0.01).Sonuç: Tramadolün 3. molar diş cerrahi çekim ağrısında fentanile ve plaseboya göre daha etkin bir analjezi sağladığı gözlenmiştir.Anahtar kelimeler: Anksiyete, bilinçli sedasyon, oral cerrahi SUMMARY Comparing the Effects of Tramadol and Fentanyl on Anxiety and Postoperaıve Pain in Impacted Third Molar SurgeryAim: This study aims to evaluate and compare the effects of fentanyl and tramadol, used in combination with midazolam in the sedation procedures in dentistry so as to alleviate anxiety and postoperative pain associated with surgical third molar extraction in scared patients. Materials and Methods:This prospective randomized double-blind, placebo-controlled study enrolled 60 ASA I-II patients who had horizontal third molar extraction operation indication with APAIS scores above 10 points. All the paients were firstly given 0.03 mg kg -1 bolus midazolam and then they were randomized into three groups as Group A, only midazolam, Group B midazolam -fentanyl (1 μg kg -1 ), Group C, midazolam -tramadol (1 mg kg -1 ) combinations, respectively. All vital signs and intraoperative phalanx sweat index (PSI) data were recorded. Patients were assessed as for postoperative pain, and adverse effects.Results: No difference was found in PSI scores between the groups. During postoperative pain assessments, VAS scores of patients in Group C were lower than the other two groups at the postoperative 1st hour (p<0.05). Time to the need of the first rescue analgesic in Groups A, B, C were reported as 3, 3.5, and 5 hours respectively, while the time interval was comparatively prolonged in Group C (p<0.01).Conclusion: Tramadol has observedly provided more effective analgesia in third molar surgery than f...

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“…Despite the widespread use of conscious sedation in a variety of fields including gastrointestinal endoscopy [1], dentistry [3], emergency medicine [4], and gynecology [5][6][7], many questions concerning the safety of conscious sedation remain unanswered. In combination, opioids and benzodiazepines have the potential for serious complications including respiratory depression and aspiration of gastrointestinal contents [8,9].…”

Section: Introductionmentioning

confidence: 99%

Low-dose fentanyl and midazolam in outpatient surgical abortion up to 18 weeks of gestation

Wilson¹,

Chen²,

Creinin³

2009

Contraception

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Background: We investigated the safety of a conscious sedation protocol using intravenous fentanyl and midazolam by direct venous injection in women who underwent outpatient surgical abortion up to 18 weeks of gestation. Study Design: This retrospective cohort study evaluated 1433 abortion procedures performed on women who received intravenous conscious sedation between April 1, 2001, and December 31, 2006. Women were allowed oral intake before the procedure. De-identified data were abstracted from charts using a standardized extraction form. Primary outcomes evaluated were need for reversal agents, need to obtain emergency intravenous access, pulmonary aspiration, need for oxygen supplementation and hospitalization for any reason. Results: Of the 1433 procedures, 410 women received sedation with continuous intravenous access, and 1023 women received sedation by direct venous injection. More than 95% of women received fentanyl 100 mcg combined with 1-2 mg of midazolam. We identified four (0.3%) instances of adverse events, none of which occurred as a result of oversedation. No women experienced oral content aspiration. Conclusions: Intravenous conscious sedation with fentanyl and midazolam is safe for outpatient surgical abortion in women without cardiovascular compromise up to 18 weeks of gestation. The risk of aspiration or oversedation requiring reversal agents is rare and does not warrant universal direct venous access or restriction of oral intake.

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Comparing efficacy and safety of four intravenous sedation regimens in dental outpatients

Cited by 72 publications

References 8 publications

Risk Factors With Intravenous Sedation for Patients With Disabilities

Risk Factors With Intravenous Sedation for Patients With Disabilities

Comparing the Effects of Tramadol and Fentanyl on Anxiety and Postoperaıve Pain in Impacted Third Molar Surgery

Low-dose fentanyl and midazolam in outpatient surgical abortion up to 18 weeks of gestation

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