Hemodynamic and ventilatory changes during implant surgery with intravenous conscious sedation

Abstract

Purpose: This study was conducted to determine the hemodynamic and ventilatory changes during implant surgery with intravenous conscious sedation, and whether preoperative anxiety, gender or age influence these parameters. Patients and Methods: A prospective study carried out between May 2004 and February 2007, on 102 patients treated with dental implants under local anesthesia and conscious intravenous sedation. Patients completed a questionnaire prior to surgery to evaluate preoperative dental anxiety using Corah's scale. The hemodynamic and ventilatory changes were evaluated by monitoring systolic pressure (SP), diastolic pressure (DP), heart rate (HR) and oxygen saturation (SaO2). These values were collected at 5 points during surgery; before commencing the operation (baseline value), during local anesthetic injection, at the moment of incision and raising of a mucoperiosteal flap, during implant placement, and finally at suturing. Intravenous conscious sedation was administered between baseline value and injection of the local anesthetic. Results: The highest SP and DP were recorded at baseline and at suturing. The highest HR was recorded at the moment of incision and raising of the mucoperiosteal flap; the lowest SaO2 was recorded at local anesthetic injection. There was no relationship between hemodynamic and ventilatory values and preoperative anxiety or gender. A greater age was associated with higher SP and lower SaO2, these differences being statistically significant. Conclusions: Most of the cardiovascular and ventilatory changes induced by the implant surgery with intravenous conscious sedation were within normal ranges. The results indicate that midazolam with fentanyl do not produce important hemodynamic and ventilatory changes, being a good association for intravenous conscious sedation in dental implant surgery.

Intravenous Moderate Sedation as an Adjunct for Periodontal Surgery: A Retrospective Analysis of 964 Cases

“…Concerning respiratory parameters, the current case series found an average intraoperative pulse oxygenation drop of 2.02%. Similarly, intraoperative pulse oxygenation dropped an average of 2.05% in the study by González‐Lemonnier et al 18 These findings are in agreement with a much larger study by Viljoen et al, 19 who evaluated oxygen saturation levels in 3,500 dental conscious‐sedation cases. The results of their study found that some patients had pulse oxygenation values drop below 94% and concluded that “a single operator/sedationist, supported by a well‐trained team of nurses, can consistently maintain safe oxygen saturation levels.” 19 …”

“…Interestingly, whereas a heart rate reduction of 9.69% was found in the present procedures, Win et al 6 reported a 10.81% increase in heart rate. A 2011 study by González‐Lemonnier et al 18 evaluating hemodynamic and respiratory changes during dental implant surgery with conscious sedation found that systolic and diastolic blood pressures dropped 7.1% and 11.4%, respectively, while heart rate increased 7.9%.…”

Monitoring cardiovascular changes due to local anesthesia during and after tooth extraction using pulse wave analysis

“…The increase in blood pressure (BP) is common even in healthy subjects. Research groups have studied the changes in blood pressure, body temperature, oxygen saturation level and heart rate in different stages of the dental surgery [1][2][3]. Gedik et al [2] has reported the factors such as patient age, gender, education and volume of anesthetic drug used are strong determinants of the extent of changes in the heart rate, blood pressure and temperature before and after oral surgery.…”

Hemodynamics during intravenous conscious sedation

“…González-Lemonnier et al [6] monitored hemodynamic and ventilator changes during implant surgery with intravenous conscious sedation using midazolam and fentanyl. They reported that the highest systolic and diastolic BPs were reported during incision and raising of the mucoperiosteal flap, whereas the lowest SpO 2 was recorded at the local anesthetic injection.…”