Abstract
AbstractAimThis retrospective observational study evaluates the safety and efficacy of intravenous sedation using midazolam only or combinations of two or three drugs including propofol and alfentanil for complex dental surgery such as implant placement or sinus augmentations.MethodsThe study analyses 60 patients aged 42–79 who required advanced sedation techniques for complex oral surgery procedures. Twenty patients had midazolam only (M), 10 patients a 2‐drug combination of midazolam and propofol (MP) and a third group of 30 patients had the combination of midazolam, propofol and alfentanil (MAP). The last two regimens were carried out under the supervision of a dedicated consultant anaesthetist.ResultsHigher mean minimum heart rate (beats/min) was observed in the midazolam group compared to the group sedated with the three‐drug regimen (p < 0.05). The time between the last drug administration (LDA) and end of surgery (EOS) was significantly longer (p < 0.005) in group M (≤45 mins) compared to the other two sedation groups MP and MAP (≤15 min). The final titration of midazolam of 11.2 ± 4 mg (5–20 mg) was significantly greater in group M than in either of group MP or MAP (p < 0.05).ConclusionIn patients requiring conscious sedation to undergo complex and lengthy oral surgery, a combination of agents (midazolam, propofol and alfentanil) can provide a predictable steady state of sedation up to the end of the surgery resulting in better operating conditions for the surgeon and improved patient co‐operation. The shorter duration of action drugs propofol and alfentanil improved haemodynamic stability, sedation quality and reduce the final doses of each sedative agent.
Highlights
Following a report published in 2000 ‘A Conscious Decision’, general anaesthesia for dental procedures has been restricted to hospital settings only in the United Kingdom.[1]
All vital signs were similar in all the sedation groups apart from a significantly higher mean minimum heart rate in the midazolam group compared to the group sedated with the three-drug regimen p < 0.05 (Table 3)
Very little is reported on the combination of the three drugs midazolam, propofol and alfentanil used together for sedation in order to carry out minor procedures
Summary
Following a report published in 2000 ‘A Conscious Decision’, general anaesthesia for dental procedures has been restricted to hospital settings only in the United Kingdom.[1] Since that time there has been an increase in the use of advanced techniques for sedation. Over the last 20 years, many advisory bodies have been involved in sedation regulation and guidelines.2–9 Attitudes towards the use of advanced sedation techniques vary widely within the dental community. Many clinicians hold the view that only the basic techniques as defined in 2007 by The Standing Committee for Sedation in Dentistry,[8] i.e. titrated doses of midazolam and/or inhalation sedation with nitrous oxide should be used, and that other techniques should not be allowed within the dental practice setting. Dental surveys have shown that over half the United Kingdom's adult population are irregular attenders due to fear,10–12 and this anxiety has increased the demand for dental conscious sedation. It has been shown that 74% of dentists in Scotland felt that there was a need for sedation in their practice.11-12
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