Optimal and safe standard doses of midazolam and propofol to achieve patient and doctor satisfaction with dental treatment: A prospective cohort study

Abstract

BackgroundThe incidences of morbidity and mortality caused by pharmacosedation for dental treatment have not yet reached zero. Adverse events are related to inappropriate respiratory management, mostly originating from an overdose of sedatives. Since sedation is utilized for the satisfaction of both the dentist and the patient, the optimal dose should be minimized to prevent adverse events. We attempted to define the optimal doses of midazolam and propofol required to achieve high levels of patient and dentist satisfaction.MethodsOne thousand dental patients, including those undergoing third molar extractions, were enrolled in this study. A dose of 1 mg of midazolam was administered at 1-minute intervals until adequate sedation was achieved. Propofol was then infused continuously to maintain the sedation level. Both the patients and the dentists were subsequently interviewed and asked to complete a questionnaire. A multivariate logistic regression analysis was used to examine the factors that contributed to patient and dentist satisfaction.ResultsThe peak midazolam dose resulting in the highest percentage of patient satisfaction was 3 mg. Both a lower dose and a higher dose reduced patient satisfaction. Patient satisfaction increased with an increasing dosage of propofol up until 4 mg/kg/hr, reaching a peak of 78.6%. The peak midazolam dose resulting in the highest percentage of dentist satisfaction (78.8%) was 2 mg. Incremental propofol doses reduced dentist satisfaction, in contrast to their effect on patient satisfaction. The strongest independent predictors of patient satisfaction and dentist satisfaction were no intraoperative memory (OR, 5.073; 95% CI, 3.532–7.287; P<0.001) and unintentional movements by the patient (OR, 0.035; 95% CI, 0.012–0.104; P<0.001), respectively. No serious adverse events were reported.ConclusionWe found that 3 mg of midazolam and 3 mg/kg/hr of propofol may be the optimal doses for maximizing both patient and dentist satisfaction. Although this level of sedation is relatively light, memory loss and an absence of unintentional patient movements can be expected without adverse events.

Contribution of benzodiazepines in dental care of patients with special needs

“…According to our results, it can be assumed that sex is not a determining factor that expresses the need for pharmacological sedation. The mean age in the studies of Jerath et al and Masuda et al were close, with the first one being 40, with a minimum age of 20 years and a maximum of 85, and the second study being 47 years, varying from 9 to 85 years old (14,19). When compared to the mean of our study (18 years), it can be observed that the means were higher; however, variations of ages were close to the present study, which presented ages from 6 to 78 years.…”

Conscious sedation for the management of dental anxiety in third molar extraction surgery: a systematic review.

“…Dental anxiety is a common aspect of oral-surgical procedures, and patients may benefit from the use of conscious sedation [10]. The advantages of conscious sedation may include lower patient anxiety [8,19,21,23,25], reduced post-surgical pain [27] increased patient and surgeon satisfaction [28], and inhibition of gag reflex [29]. In addition, it can be safely delivered in a non-operating room environment [30] and to patients with challenging behaviors as an alternative to general anesthesia [5].…”

Обзор Современных Клинических Рекомендаций По Амбулаторной Седации

“…Для пацієнта має значення якість медикаментозного сну, ступінь задоволення та зручність на всіх етапах лікування. Наприклад, психологічний комфорт при спілкуванні з медичним персоналом перед процедурою; застосування заспокійливих лікарських засобів премедикації для зменшення тривоги та страху; відсутність болісних подразників, епізодів відновлення свідомості, галюцинацій під час лікування та різноманітних ускладнень після нього, таких як біль, нудота, подовжене пробудження або безсоння; адекватне знеболення, можливість вести звичний спосіб життя в післяопераційному періоді [16,17]. Сучасні дослідження доводять високий ступінь ефективності при застосуванні різноманітних методик седації [18,19].…”