Paradoxical Reaction to Midazolam Used in Intravenous Sedation for Dental Treatment: Report of a Case and Review of the Literature

Intravenous sedation with propofol is often administered to anxious patients in dental practice. Pain on injection of propofol is a common adverse effect. This study aimed to determine the age-adjusted doses of midazolam required to erase memory of vascular pain of propofol administration and assess whether the Ramsay Sedation Scale (RSS) after the pretreatment of midazolam was useful to predict amnesia of the vascular pain of propofol administration. A total of 246 patients with dental phobia requiring dental treatment under intravenous sedation were included. Patients were classified according to their age: 30s, 40s, 50s, and 60s. Three minutes after administration of a predetermined dose of midazolam, propofol was infused continuously. After completion of the dental procedure, patients were interviewed about the memory of any pain or discomfort in the injection site or forearm. The dosage of midazolam was determined using the Dixon up-down method. The first patient was administered 0.03 mg/kg, and if memory of vascular pain remained, the dosage was increased by 0.01 mg/kg for the next patient, and then if the memory was erased, the dosage was decreased by 0.01 mg/kg. The effective dosage of midazolam in 95% of each age group for erasing the memory of propofol vascular pain (ED95) was determined using logistic analysis. The accuracy of RSS to predict the amnesia of injection pain was assessed by receiver operating characteristic (ROC) analysis. The ED95 of midazolam to erase the memory of propofol vascular pain was 0.061 mg/kg in patients in their 30s, 0.049 mg/kg in patients in their 40s, 0.033 mg/kg in patients in their 50s, and 0.033 mg/kg in patients in their 60s. The area under the ROC curve was 0.31. The ED95 of midazolam required to erase the memory of propofol vascular pain demonstrated a downward trend with age. On the other hand, it was impossible to predict the amnesia of propofol vascular pain using the RSS.

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Patient Satisfaction in Medicine and Dentistry: A Need to Advance to a Patient-Reported Outcome Measures (PROMs) Culture in Surgical Sciences

10.20944/preprints202009.0254.v1 ◽

2020 ◽

Author(s):

Kelvin I. Afrashtehfar ◽

Mansour K. A. Assery

Keyword(s):

Patient Satisfaction ◽

Dental Treatment ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Review Of The Literature ◽

Participant Satisfaction ◽

Patient Reported ◽

Current Article ◽

Negative Feelings ◽

Perceived Reasons

There is little understanding of patients' experiences and perceptions with satisfaction by health professionals such as medical and dental clinicians. Furthermore, patient satisfaction is not well understood. The objective of this article is to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of the treatment influence participant satisfaction at different stages of the intervention's process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. The consumerist method may misrepresent the concept of satisfaction in health service.

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Impact of Dental Treatment under General Anesthesia or Intravenous Sedation on Oral Health-related Quality of Life in Pediatric Dental Patients

THE JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY ◽

10.5933/jkapd.2016.43.1.27 ◽

2016 ◽

Vol 43 (1) ◽

pp. 27-35 ◽

Cited By ~ 1

Author(s):

Jisoo Song ◽

Youngjae Kim

Keyword(s):

Quality Of Life ◽

Oral Health ◽

General Anesthesia ◽

Dental Treatment ◽

Intravenous Sedation ◽

Health Related Quality ◽

Dental Patients ◽

Related Quality ◽

Health Related

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Independent Factors Affecting Recovery Time After Sedation in Patients with Intellectual Disabilities

The Open Dentistry Journal ◽

10.2174/1874210601509010146 ◽

2015 ◽

Vol 9 (1) ◽

pp. 146-149 ◽

Cited By ~ 2

Author(s):

Shigeru Maeda ◽

Yumiko Tomayasu ◽

Hitoshi Higuchi ◽

Minako Ishii-Maruhama ◽

Ayaka Yamane ◽

...

Keyword(s):

Intellectual Disabilities ◽

Psychotropic Drugs ◽

Recovery Time ◽

Dental Treatment ◽

Outcome Variable ◽

Intravenous Sedation ◽

Factors Affecting ◽

Oral Midazolam ◽

Prolonged Recovery ◽

Independent Determinant

Purpose:The purpose of this study was to identify independent factors associated with prolonged recovery time after intravenous sedation for dental treatment in patients with intellectual disabilities.Methods:This study was designed as a prospective cohort study. Participants were patients with intellectual disabilities, for whom sedation for dental treatment was planned in Okayama University Hospital. The outcome variable was recovery time. The predictor variables were patient background, antiepileptic and psychotropic drugs, and anesthesia-related variables. Factors affecting the outcome were examined with multiple regression analysis.Results:We enrolled 260 cases in this study. Oral midazolam was a strong independent determinant in prolonged recovery time. Teeth extraction, short treatment time and lower body mass index were significant independent predictors of prolonged recovery time.Conclusion:Oral midazolam is a clear independent determinant of prolonged recovery time after sedation, while psychotropic drugs and antiepileptic drugs were not independent determinants in this study.

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Intravenous Sedation in Arnold-Chiari Malformation With Respiratory Failure

Anesthesia Progress ◽

10.2344/anpr-66-01-06 ◽

2019 ◽

Vol 66 (1) ◽

pp. 37-41 ◽

Cited By ~ 2

Author(s):

Yoshiki Shionoya ◽

Eishi Nakamura ◽

Takahiro Goi ◽

Kiminari Nakamura ◽

Katsuhisa Sunada

Keyword(s):

Respiratory Failure ◽

Respiratory Depression ◽

Chiari Malformation ◽

Dental Treatment ◽

Anesthetic Management ◽

Cranial Nerves ◽

Intravenous Sedation ◽

Type Ii ◽

Neck Extension ◽

Arnold Chiari Malformation

Type II Arnold-Chiari malformation (ACM) is an abnormality in which the cerebellum, pons, and medulla oblongata are displaced downward into the spinal cord. Type II ACM is often complicated by respiratory depression, sleep-disordered breathing, and deglutition disorder as a result of medullary dysfunction and impairment of the lower cranial nerves. Bending and stretching of the neck is restricted, and anesthetic management is problematic in patients with the disorder. We performed dental treatment twice under intravenous sedation in a patient with intellectual disability with type II ACM complicated by hypercapnic respiratory failure. Propofol was used for the first sedation procedure. Repeated bouts of respiratory depression occurred on that occasion, so the airway was managed manually by lifting the jaw. However, aspiration pneumonitis occurred postoperatively. A combination of dexmedetomidine and midazolam was used for sedation on the second occasion, and the intervention was completed uneventfully without any respiratory depression. Our experience with this patient highlights the need for selection of an agent for intravenous sedation that does not require neck extension and has minimal effect on respiration in patients with type II ACM, who are at high risk of respiratory depression and pulmonary aspiration.

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Anesthetic Management of a Patient With Hereditary Angioedema for Oral Surgery

Anesthesia Progress ◽

10.2344/anpr-65-04-01 ◽

2019 ◽

Vol 66 (1) ◽

pp. 30-32

Author(s):

Rumiko Hosokawa ◽

Masanori Tsukamoto ◽

Saki Nagano ◽

Takeshi Yokoyama

Keyword(s):

Hereditary Angioedema ◽

Tooth Extraction ◽

Dental Treatment ◽

Oral Surgery ◽

Anesthetic Management ◽

Treatment Options ◽

Third Molar ◽

Intravenous Sedation ◽

C1 Inhibitor ◽

Impacted Third Molar

Hereditary angioedema (HAE) is a rare genetic disease that results from deficiency or dysfunction of C1 inhibitor (C1-INH). This disease is characterized by sudden attacks of angioedema. When edema occurs in the pharynx or larynx, it can lead to serious airway compromise, including death. Physical and/or psychological stress can trigger an attack. Dental treatment, including tooth extraction, is also a recognized trigger. We report a case of a 20-year-old male with HAE who required impacted third molar extractions. C1-INH concentrate was administered 1 hour before surgery, which was completed under deep intravenous sedation. This report describes the anesthetic management of a patient with HAE and reviews treatment options and concerns.

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Treatment planning in the presence of congenitally absent second premolars: a review of the literature

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.27.1.5q06x95w2p657107 ◽

2003 ◽

Vol 27 (1) ◽

pp. 13-17 ◽

Cited By ~ 10

Author(s):

Lori Lee Santos

Keyword(s):

Treatment Planning ◽

Dental Treatment ◽

Treatment Plan ◽

Comprehensive Treatment ◽

Review Of The Literature ◽

Diagnostic Challenge ◽

Pediatric Dentist ◽

Number Of Factors ◽

Appropriate Treatment ◽

Deciduous Molar

One of the most common dental anomalies encountered by the pediatric dentist is the congenital absence of second premolars. Once diagnosed, the appropriate treatment necessitates the formulation of a comprehensive treatment plan, which is dependent upon a number of factors. Considerations include: the condition of the deciduous molar, dental and skeletal relationships, dental age of the patient, willingness of the patient to undergo extensive dental treatment and financial considerations. Approaches to the management of congenitally missing premolars have been described in the literature, including the more recently available option of dental implant placement. The objective of this paper is to present a review of the literature with emphasis on the considerations needed for appropriate treatment planning when the practitioner is confronted with this diagnostic challenge.

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Anesthetic Management of a Patient With Citrullinemia Type I During Dental Treatment

Anesthesia Progress ◽

10.2344/anpr-68-02-04 ◽

2021 ◽

Vol 68 (3) ◽

pp. 158-162

Author(s):

Makiko Shibuya ◽

Rie Iwamoto ◽

Yukifumi Kimura ◽

Nobuhito Kamekura DDS ◽

Toshiaki Fujisawa

Keyword(s):

Dental Treatment ◽

Genetic Disorder ◽

Anesthetic Management ◽

Third Molar ◽

Intravenous Sedation ◽

Type I ◽

Oral Medications ◽

Gag Reflex ◽

Serum Ammonia ◽

Citrullinemia Type I

We report a case involving intravenous sedation for third molar extractions in a 32-year-old man with citrullinemia type I (CTLN1), a genetic disorder that affects the urea cycle. The patient was diagnosed with CTLN1 after he exhibited seizures soon after birth and was intellectually disabled because of persistent hyperammonemia, although his recent serum ammonia levels were fairly well controlled. We planned to minimize his preoperative fasting, continue his routine oral medications, and monitor his serum ammonia levels at least twice. Sedation with midazolam and a propofol infusion was planned to suppress his gag reflex and reduce protein hypercatabolism due to stress. Epinephrine-containing local anesthetics, which enhance protein catabolism, were avoided, replaced by plain lidocaine for blocks and prilocaine with felypressin for infiltration anesthesia. No significant elevation in ammonia levels was observed. In patients with CTLN1, sedation can be useful for preventing hyperammonemia. Patients who develop symptomatic hyperammonemia may require urgent/emergent treatment involving other medical specialists. Therefore, preoperative endocrinology consultation, perioperative monitoring of serum ammonia levels, and preemptively coordinating for appropriate care in the event hyperammonemia occurs should all be considered.

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Diagnosis and Treatment of Atypical Odontalgia: A Review of the Literature and Two Case Reports

The Journal of Contemporary Dental Practice ◽

10.5005/jcdp-8-3-81 ◽

2007 ◽

Vol 8 (3) ◽

pp. 81-89 ◽

Cited By ~ 14

Author(s):

Marcello Melis ◽

Simona Secci

Keyword(s):

Differential Diagnosis ◽

Tricyclic Antidepressants ◽

Myofascial Pain ◽

Dental Treatment ◽

Case Reports ◽

Correct Diagnosis ◽

Diagnosis And Treatment ◽

Review Of The Literature ◽

Atypical Odontalgia ◽

The Subject

Abstract Aim This report presents two cases diagnosed with atypical odontalgia (AO) and successfully treated with amitriptyline as well providing a review of the current literature on the subject. Results The literature indicates the most important issue is an accurate differential diagnosis to distinguish between AO, pulpal pain, myofascial pain, and trigeminal neuralgia. Conclusion Once the correct diagnosis is made the prognosis of AO is usually fair and the administration of tricyclic antidepressants often resolves symptoms. An effort should be made to avoid any unnecessary dental treatment that would only aggravate the problem. Citation Melis M, Secci S. Diagnosis and Treatment of Atypical Odontalgia: A Review of the Literature and Two Case Reports. J Contemp Dent Pract 2007 March;(8)3:081-089.

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