下顎埋伏智歯抜歯術における骨削除時の血漿カテコールアミン濃度ならびに循環動態に及ぼす影響

Abstract

The extraction of impacted third molars is a rather invasive procedure among dental treatments. In this study, how the sound and stress of the extraction of impacted third molars affects patients was objectively evaluated by examining changes in plasma catecholamine concentrations and hemodynamics. We also examined whether intravenous sedation was useful for the management of problems associated with extraction.Twenty healthy patients who had impacted third molars (Class I Position A) were randomly assigned to receive local anesthesia (LA group, n=9) or intravenous sedation with midazolam (IVS group, n=11). Both groups received infiltration anesthesia with 3.6ml of 3% hydrochloric acid propitocaine with felypressin. The bone was removed with a bone chisel and mallet. Study variables were measured at five time points: after local anesthesia, before bone removal, during bone removal, after bone removal, and just after the end of operation.The plasma epinephrine concentration in the WS group was significantly lower than that in the LA group at all time points. The plasma norepinephrine concentration in the WS group was significantly lower than that in the LA group before and during bone removal. Hemodynamics did not significantly differ between the groups.Intravenous sedation with midazolam was considered a useful method to suppress the stress of patients caused by bone removal during the extraction of impacted third molars.