scholarly journals Assessment of patient’s anxiety and expectation associated with hemodynamic changes during surgical procedure under local anesthesia

2017 ◽  
Vol 46 (5) ◽  
pp. 299-306
Author(s):  
Marcos Vinícius Mendes DANTAS ◽  
Bianca NESSO ◽  
Daniel Sagawa MITUUTI ◽  
Marisa Aparecida Cabrini GABRIELLI

Abstract Introduction The dental patient’s anxiety and expectation may significantly alter their vital signs. The use of local anesthetics associated with a vasoconstrictor may also alter the vital signs of these patients, promoting hemodynamic changes that may result in emergency situations. Objective To evaluate the influence of anxiety of patients submitted to third molar extraction and the use of different anesthetic substances with adrenaline on their vital signs (oxygen saturation, heart rate, and systolic and diastolic blood pressure) in different moments. Material and method Forty patients answered the questionnaire of the Dental Anxiety Scale (Corah’s Scale) and fear (KleinKnecht’s Scale) and were submitted to third molar extraction in two surgical times for the use of articaine or mepivacaine, both associated with adrenaline. The results were analyzed by ANOVA followed by Tukey post hoc test, Student's t test, and Pearson's correlation coefficients (α=0.05). Result There was no significant differences in saturation or heart rate. The blood pressure showed significant variations during time for both anesthetics, however mepivacaine resulted in a longer postoperative time to restore blood pressure. Patients with high or moderate anxiety and high fear index were those who had positive correlations with the highest blood pressure values. Conclusion Anxiety and fear positively influence the increase in blood pressure. Mepivacaine promoted a greater resistance to the return of normal vital signs, especially blood pressure levels.

2020 ◽  
Author(s):  
Matteo Melini ◽  
Andrea Forni ◽  
Francesco Cavallin ◽  
Matteo Parotto ◽  
Gastone Zanette

Abstract Background: Dental anxiety is a condition associated with avoidance of dental treatment and increased medical and surgical risks. This systematic review aims to summarize available evidence on conscious sedation techniques used for the management of Dental anxiety in patients scheduled for third molar extraction surgery, to identify best approaches and knowledge gaps. Methods: A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane Database of Systematic Reviews through March 2019. Only randomized controlled trials were included. PRISMA guidelines were followed. Risk of bias was appraised as reported in the Cochrane Handbook for Systematic Reviews of Interventions. Results: Seventeen RCTs with a total of 1,788 patients were included. Some aspects limited the feasibility of a meaningful meta-analysis, thus a narrative synthesis was conducted. Conscious sedation was associated with improvement in Dental anxiety in six studies. One study reported lower cortisol levels with midazolam vs. placebo, while another study found significant variation in perioperative renin levels with remifentanil vs. placebo. Conclusions: This review found inconclusive and conflicting findings about the role of Conscious sedation in managing Dental anxiety during third molar extraction surgery. Relevant questions remain unanswered due to the lack of consistent, standardized outcome measures. Future research may benefit from addressing these limitations in study design.


Author(s):  
Zainab Alghareeb ◽  
Kawther Alhaji ◽  
Bayan Alhaddad ◽  
Balgis Gaffar

Abstract Objectives This study aimed to investigate hemodynamic changes in healthy adult patients during different dental procedures and evaluate whether these changes were associated with patients' dental anxiety. Materials and Methods A convenience sample of 119 patients of both genders undergoing routine dental care participated in the study. Participants responded to the Arabic version of the modified dental anxiety scale (MDAS) and a self-structured questionnaire. Each patient had their blood pressure, heart rate, and oxygen saturation measured at three points: before, during, and after the dental procedure using an electronic sphygmomanometer. MDAS scores were categorized into no anxiety, mild, moderate or severe anxiety, while readings of heart rate and blood pressure were categorized into no change, increased or decreased and either “no change” or “increased” for oxygen saturation. Chi-square test was used to investigate the association between the study variables and a p value of < 0.05 was considered statistically significant. SPSS version 20 was used in the analysis. Results Mean ( ± standard deviation [SD]) of MDAS was 11.12 ( ±  3.9) an indicative of moderate dental anxiety. No changes in blood pressure, heart rate, or in oxygen saturation were observed on 39.5%, 54.6% and 97.5% among the study participants, respectively. Half of the participants avoided dental care, with dental anxiety being the main reason for that (26.1%). Pattern of dental visits was significantly associated with MDAS scores (p = 0.042). There were significant changes in blood pressure (p = 0.0003), heart rate (p = 0.01) but not in oxygen saturation (p = 0.33). Changes in blood pressure, heart rate, and oxygen saturation were not associated with dental anxiety p = 0.15, 0.10, and 0.99, respectively. Conclusion The results of this study indicate that the type of dental procedure may cause dental anxiety and cause hemodynamic changes. Therefore, close monitoring of patients with dental anxiety during the treatment is advised.


2020 ◽  
Author(s):  
Matteo Melini ◽  
Andrea Forni ◽  
Francesco Cavallin ◽  
Matteo Parotto ◽  
Gastone Zanette

Abstract Background: Dental anxiety is a condition associated with avoidance of dental treatment and increased medical and surgical risks. This systematic review aims to summarize available evidence on conscious sedation techniques used for the management of Dental anxiety in patients scheduled for third molar extraction surgery, to identify best approaches and knowledge gaps. Methods: A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane Database of Systematic Reviews through March 2019. Only randomized controlled trials were included. PRISMA guidelines were followed. Risk of bias was appraised as reported in the Cochrane Handbook for Systematic Reviews of Interventions. Results: Seventeen RCTs with a total of 1,788 patients were included. Some aspects limited the feasibility of a meaningful meta-analysis, thus a narrative synthesis was conducted. Conscious sedation was associated with improvement in Dental anxiety in six studies. One study reported lower cortisol levels with midazolam vs. placebo, while another study found significant variation in perioperative renin levels with remifentanil vs. placebo. Conclusions: This review found inconclusive and conflicting findings about the role of Conscious sedation in managing Dental anxiety during third molar extraction surgery. Relevant questions remain unanswered due to the lack of consistent, standardized outcome measures. Future research may benefit from addressing these limitations in study design.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Matteo Melini ◽  
Andrea Forni ◽  
Francesco Cavallin ◽  
Matteo Parotto ◽  
Gastone Zanette

2018 ◽  
Vol 17 (2) ◽  
pp. 11
Author(s):  
Krishna Gopal Bhuju ◽  
Sujita Shrestha ◽  
Riwaj Karki ◽  
Sameer Aryal

<p><strong>Aim</strong>: To study the effect of age, gender, side and impaction types on surgical difficulty during mandibular third molar extraction through the data collected over a period of one year by single maxillofacial surgeon. All the extractions were performed under the same environment and conditions.</p><p><strong>Methods</strong>: Descriptive clinical study of 401 patients was carried out between the ages of 16 to 45years. Age, gender, impaction side and impaction types (according to the winter classification) were recorded on proforma. Duration of surgery for each patient was recorded after starting incision to the completion of suture which was divided into less than 10 minutes (mild), 11 to 20 minutes (moderate) and above 21 minutes (severe). Pearson’s Chi-square test was used for data analysis and significance level was less than or equal to 0.05.</p><p><strong>Results</strong>: Among 401 participants, 225 (56.1%) were male and 176 (43.9%) were female. Mean age was 31.5 years and mean operation time was 17.59 minutes. After statistical analysis there was a significant correlation among gender and side of impaction where <em>p </em>value is 0.043 0.048 respectively.</p><p><strong>Conclusion</strong>: There is a statistically significant correlation between gender and side of impaction with duration of surgery which is considered as the objective measure of surgical difficulty whereas age and impaction types didn’t show any significant correlation. </p>


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 914.2-914
Author(s):  
S. Boussaid ◽  
M. Ben Majdouba ◽  
S. Jriri ◽  
M. Abbes ◽  
S. Jammali ◽  
...  

Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared


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