Risk factor analysis of additional administration of sedative agent and patient dissatisfaction in intravenous conscious sedation using midazolam for third molar extraction
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Objectives: The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intrave-nous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction.Materials and Methods: Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer’s assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05.Results: Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; how-ever, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction. Conclusion: The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral sur-gery under IVS. The amnesia about the procedure affects patient satisfaction positively.
Abstract
Objectives: The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intrave-nous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction.Materials and Methods: Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer’s assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05.Results: Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; how-ever, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction. Conclusion: The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral sur-gery under IVS. The amnesia about the procedure affects patient satisfaction positively.
참고문헌 (29)
- Van der Bijl P, "Intravenous midazolam in oral surgery", Int J Oral Maxillofac Surg, 16, pp.325~332 (1987)
- Rodgers SF, "Safety of intravenous sedation administered by the operating oral surgeon: the second 7 years of office practice", J Oral Maxillofac Surg, 69, pp.2525~2529 (2011)
- Dundee JW, "Midazolam. A review of its pharmacological properties and therapeutic use", Drugs, 28, pp.519~543 (1984)
- Agostoni M, "Midazolam and pethidine versus propofol and fentanyl patient controlled sedation", analgesia for upper gastrointestinal tract ultrasound endoscopy: a prospective randomized controlled trial, 2007, pp.39, 1024~1029
- Ryu DS, "Sedation protocol using dexmedetomidine for third molar extraction", J Oral Maxillofac Surg, 74, pp.926.e1~926.e7 (2016)
- Sharma VK, "A national study of cardiopulmonary unplanned events after GI endoscopy", Gastrointest Endosc, 66, pp.27~34 (2007)
- Aldrete JA, "Modifications to the postanesthesia score for use in ambulatory surgery", J Perianesth Nurs, 13, pp.148~155 (1998)
- Koerner KR, "The removal of impacted third molars. Principles and procedures", Dent Clin North Am, 38, pp.255~278 (1994)
- Corah NL, "Development of a dental anxiety scale", J Dent Res, 48, pp.596~ (1969)
- Chernik DA, "Validity and reliability of the Observer's Assessment of Alertness", Sedation Scale: study with intravenous midazolam, 1990, pp.10, 244~251
- Göktay O, "A comparison of the effects of midazolam", fentanyl and midazolam, J Oral Maxillofac Surg, pp.2011, 69[DOI]
- Ustün Y, "Dexmedetomidine versus midazolam in outpatient third molar surgery", J Oral Maxillofac Surg, 64, pp.1353~1358 (2006)
- Moore PA, "Multidrug intravenous sedation:determinants of the sedative dose of midazolam", Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 84, pp.5~10 (1997)
- Zacharias M, "Patient-controlled sedation using midazolam", Br J Oral Maxillofac Surg, 32, pp.168~173 (1994)
- Jirapinyo P, "Conscious sedation for upper endoscopy in the gastric bypass patient: prevalence of cardiopulmonary adverse events and predictors of sedation requirement", Dig Dis Sci, 59, pp.2173~2177 (2014)
- Maeda S, "Independent factors affecting recovery time after sedation in patients with intellectual disabilities", Open Dent J, 9, pp.146~149 (2015)
- Brill MJ, "Midazolam pharmacokinetics in morbidly obese patients following semi-simultaneous oral and intravenous administration: a comparison with healthy volunteers", Clin Pharmacokinet, 53, pp.931~941 (2014)
- Cillo JE Jr, "Correlation and comparison of body mass index on hemodynamics in hypertensive and normotensive patients undergoing intravenous sedation", J Oral Maxillofac Surg, 64, pp.583~588 (2006)
- Moretto M, "Hepatic steatosis in patients undergoing bariatric surgery and its relationship to body mass index and co-morbidities", Obes Surg, 13, pp.622~624 (2003)
- Czwornog J, "Body mass index, age, and gender affect prep quality, sedation use, and procedure time during screening colonoscopy", Dig Dis Sci, 58, pp.3127~3133 (2013)
- Mika Seto, "Sedative methods used during extraction of wisdom teeth in patients with a high level of dental anxiety", 대한구강악안면외과학회지, 37(3), pp.241~244 (2011), 대한구강악안면외과학회
- Levitzky BE, "Moderate sedation for elective upper endoscopy with balanced propofol versus fentanyl and midazolam alone: a randomized clinical trial", Endoscopy, 44, pp.13~20 (2012)
- Diercke K, "The management of dental anxiety and impact of psychosomatic factors on dentistry: is recent scientific research translated into German dental practices?", J Health Psychol, 18, pp.1519~1528 (2013)
- Liu J, "Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation", Anesthesiology, 84, pp.64~69 (1996)
- Sleigh JW, "The bispectral index: a measure of depth of sleep?", Anesth Analg, 88, pp.659~661 (1999)
- Chisholm CJ, "Comparison of electrophysiologic monitors with clinical assessment of level of sedation", Mayo Clin Proc, 81, pp.46~52 (2006)
- Shah P, "Bispectral index (BIS) monitoring of intravenous sedation for dental treatment", SAAD Dig, 30, pp.7~11 (2014)
- Munoz Garcia J, "Utility of bispectral index monitoring during intravenous sedation in the dental office", Int J Oral Maxillofac Implants, 27, pp.375~382 (2012)
- Bower AL, "Bispectral index monitoring of sedation during endoscopy", Gastrointest Endosc, 52, pp.192~196 (2000)