ABSTRACT
OBJECTIVES: The efficacy of multidrug intravenous sedation regimens in oral surgery is based on the ability to titrate opioids, benzodiazepines, and barbiturates to a desired level of relaxation. Dosage requirements to reach the initial sedation end points of slurred speech and ptosis of eyelids vary widely from one patient to another. STUDY DESIGN: An assessment of physical, cardiovascular, behavioral, and pharmacologic factors that might predict midazolam dosage requirements for the initial sedation titration was carried out with data collected from a large controlled clinical trial of fentanyl, midazolam, and methohexital sedation for third molar surgery. RESULTS: Dosage requirements for the initial titration of midazolam were found to be significantly higher when fentanyl was not included in the sedation regimen and when presedation heart rate and presedation systolic blood pressure were elevated.
Subject(s)
Anesthesia, Dental/methods , Anesthetics, Combined/administration & dosage , Anesthetics, Intravenous/administration & dosage , Anti-Anxiety Agents/administration & dosage , Conscious Sedation/methods , Hypnotics and Sedatives/administration & dosage , Midazolam/administration & dosage , Adolescent , Adult , Analysis of Variance , Blood Pressure/drug effects , Chi-Square Distribution , Dental Anxiety/prevention & control , Dose-Response Relationship, Drug , Double-Blind Method , Female , Fentanyl/administration & dosage , Heart Rate/drug effects , Humans , Male , Methohexital/administration & dosage , Molar, Third/surgery , Pain Measurement , Preanesthetic Medication , Titrimetry , Tooth Extraction , Tooth, Impacted/surgeryABSTRACT
The addition of a benzodiazepine antagonist to the dental anesthesiologist's armamentarium should provide added safety for conscious sedation using benzodiazepines. A double-blind, placebo-controlled clinical trial of flumazenil, the first available benzodiazepine antagonist, was performed to evaluate its safety and efficacy following conscious sedation induced by diazepam and fentanyl. Flumazenil was found to reverse rapidly much of the central nervous system depression induced by fentanyl and diazepam conscious sedation. Flumazenil appears to be a valuable adjunct for dentists who administer intravenous benzodiazepines for conscious sedation.
Subject(s)
Anesthetics, Intravenous/antagonists & inhibitors , Conscious Sedation/methods , Diazepam/antagonists & inhibitors , Fentanyl/antagonists & inhibitors , Flumazenil/pharmacology , GABA Antagonists/pharmacology , Hypnotics and Sedatives/antagonists & inhibitors , Adult , Analysis of Variance , Anesthesia Recovery Period , Anesthesia, Dental/methods , Double-Blind Method , Female , Humans , Male , Middle AgedABSTRACT
Benzodiazepines, including diazepam and midazolam, have proved to be safe and effective for intravenous conscious sedation. Their selective anxiolytic activity and wide margin of safety contribute to their popularity. The recent introduction of the benzodiazepine receptor antagonist, flumazenil, provides flexibility and added safety for intravenous benzodiazepine sedation.
Subject(s)
Anesthesia, Dental/methods , Benzodiazepines/pharmacology , Conscious Sedation/methods , Flumazenil/pharmacology , Benzodiazepines/antagonists & inhibitors , Benzodiazepines/pharmacokinetics , Diazepam/antagonists & inhibitors , Diazepam/pharmacokinetics , Diazepam/pharmacology , Flumazenil/pharmacokinetics , Humans , Injections, Intravenous , Lorazepam/pharmacokinetics , Lorazepam/pharmacology , Midazolam/antagonists & inhibitors , Midazolam/pharmacokinetics , Midazolam/pharmacologyABSTRACT
This double-blind, controlled clinical trial assessed the anxiety relief provided by oral triazolam given before intravenous sedation. Twenty-two healthy adults undergoing third-molar surgery with intravenous sedation were enrolled in this study. Subjects were randomly assigned to receive either 0.25 mg of triazolam p.o. or an identically appearing placebo 45 to 60 min before venipuncture. Immediately before test drug administration, subjects completed the Corah Anxiety Scale, a Visual Analog Scale (VAS) assessing state anxiety, and the Interval Scale of Anxiety Response (ISAR). The VAS and ISAR were repeated immediately before venipuncture. Intravenous sedation medications consisted of fentanyl, midazolam, and methohexital. At 24 hr, assessments of the venipuncture and global experience were obtained. Results indicated that the characteristics of the triazolam and placebo patients were similar at baseline. With triazolam pretreatment, both the VAS and ISAR scores decreased significantly. Dose requirements for conscious sedation medications were decreased in the triazolam group. Patients rated the venipuncture experience significantly less unpleasant when pretreated with triazolam, and global ratings of the overall surgical experience favored triazolam. An oral-intravenous combination sedation technique using 0.25 mg of triazolam may have a significant therapeutic advantage for outpatient oral surgery.
Subject(s)
Anesthesia, Dental/methods , Conscious Sedation/methods , Dental Anxiety/drug therapy , Preanesthetic Medication/methods , Triazolam/therapeutic use , Adolescent , Adult , Analysis of Variance , Double-Blind Method , Female , Fentanyl/administration & dosage , Humans , Male , Manifest Anxiety Scale , Methohexital/administration & dosage , Midazolam/administration & dosage , Pain MeasurementABSTRACT
This article defines the specific situations in which pharmacologic management and treatment of dental anxiety are appropriate and the services of a dentist anesthesiologist are required.
Subject(s)
Anxiety/drug therapy , Dental Care/psychology , Phobic Disorders/drug therapy , Adult , Anxiety/therapy , Behavior Therapy , Drug Hypersensitivity/prevention & control , Emergencies , Female , Humans , Infant , Male , Middle Aged , Phobic Disorders/therapyABSTRACT
The case reported is typical of narcotic overdose. The sequence of events, however, is predictable when narcotics are administered in excess. Effective monitoring and the use of emergency equipment can prevent a fatality.
Subject(s)
Alphaprodine/adverse effects , Anesthesia, Dental/adverse effects , Preanesthetic Medication/adverse effects , Respiratory Insufficiency/chemically induced , Alphaprodine/administration & dosage , Child, Preschool , Humans , Male , Naloxone/administration & dosageABSTRACT
A review of the English literature on the pharmacologic effects of scopolamine is presented and indications for the current use of the drug in dental anesthesia and analgesia are evaluated. The authors conclude that the role of scopolamine in the production of conscious sedation for outpatient dental surgery should be reevaluated in the light of contemporary findings.
