scholarly journals The Effect of Adding Midazolam to Propofol Intravenous Sedation to Suppress Gag Reflex During Dental Treatment

2018 ◽  
Vol 65 (2) ◽  
pp. 76-81
Author(s):  
Toru Yamamoto ◽  
Keiko Fujii-Abe ◽  
Haruhisa Fukayama ◽  
Hiroshi Kawahara
Keyword(s):  
Dental Treatment ◽  
Cardiovascular Effects ◽  
Intravenous Sedation ◽  
Respiratory Compromise ◽  
Cardiovascular Adverse Event ◽  
Event Frequency ◽  
Treatment Interruptions ◽  
Respiratory Event ◽  
Gag Reflex ◽  
Dental Mirror

We retrospectively investigated the efficacy and safety of propofol administration alone and in combination with midazolam for gag reflex suppression during dental treatment under intravenous sedation. We included 56 patients with an overactive gag reflex who were to undergo dental treatment under intravenous sedation. They were divided into propofol (P group, n = 22) and midazolam with propofol (MP group, n = 34) groups. The P group received propofol alone, while the MP group received midazolam (0.04 mg/kg) prior to target-controlled infusion (TCI) of propofol (titrated for adequate sedation). The patients' anesthetic records were evaluated for vital sign changes, adverse cardiovascular or respiratory event frequency, the number of forced treatment interruptions, and the TCI-predicted cerebral propofol concentration at gag reflex suppression (posterior tongue stimulation with a dental mirror). No significant differences were observed between the 2 groups preoperatively. There were no cases of forced interruptions or significant respiratory compromise in either group. Cardiovascular adverse event frequency was lower in the MP group than in the P group (all p < .05). Our results suggest that propofol, when combined with midazolam, minimized cardiovascular effects compared with propofol alone when used to suppress the gag reflex in patients during dental treatment under intravenous sedation.

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

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.

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

2009 ◽  
Vol 9 (2) ◽  
pp. 104 ◽  
Author(s):  
Jae-Yun Jeon ◽  
Se-Hwa Jung ◽  
Byung-Ha Lee ◽  
Jae-Jung Im ◽  
Kyung-Gyun Hwang ◽  
...  
Keyword(s):  
Dental Treatment ◽  
Intravenous Sedation ◽  
Review Of The Literature ◽  
Paradoxical Reaction

scholarly journals Effective Dosage of Midazolam to Erase the Memory of Vascular Pain During Propofol Administration

2016 ◽  
Vol 63 (3) ◽  
pp. 147-155 ◽  
Author(s):  
Aiji Boku ◽  
Mika Inoue ◽  
Hiroshi Hanamoto ◽  
Aiko Oyamaguchi ◽  
Chiho Kudo ◽  
...  
Keyword(s):  
Roc Analysis ◽  
Operating Characteristic ◽  
Dental Treatment ◽  
Common Adverse Effect ◽  
Effective Dosage ◽  
Injection Pain ◽  
Intravenous Sedation ◽  
Logistic Analysis ◽  
Ramsay Sedation Scale ◽  
Vascular Pain

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.

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

2015 ◽  
Vol 9 (1) ◽  
pp. 146-149 ◽  
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.

scholarly journals Cardiovascular Effects of Sedative Infusions of Propofol and Midazolam after Spinal Anaesthesia

1988 ◽  
Vol 16 (3) ◽  
pp. 292-298 ◽  
Author(s):  
D. W. Blake ◽  
G. Donnan ◽  
J. Novella ◽  
C. Hackman
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Spinal Anaesthesia ◽  
Forearm Blood Flow ◽  
Recovery Period ◽  
Cardiovascular Effects ◽  
Pelvic Surgery ◽  
Control Group ◽  
Intravenous Sedation ◽  
The Difference

The cardiovascular effects of intravenous sedation were studied in fifty patients after spinal anaesthesia for lower limb or pelvic surgery. Twenty patients received propofol (mean dosage 74 (SD 4) μg/kg/min for 0–20 minutes and 51 (SD 7) μg/kg/min for 20–40 minutes), twenty received midazolam (35 μg/kg + 2.54 (SD 0.2) μg/kg/min for 0–20 minutes and 1.35 (SD 0.2) μg/kg/min for 20–40 minutes) and ten patients received saline infusion only. The forearm vasoconstriction in response to the spinal anaesthesia was measured by strain gauge plethysmography. Spinal anaesthesia lowered systolic and diastolic blood pressure by 18 (SED 4) mmHg and 9 (SED 2) mmHg respectively. (SED = standard error of the difference.) This was associated with a 32% decrease in mean forearm blood flow. Propofol and midazolam caused similar additional reductions in systolic and diastolic blood pressure (10 (SED 4) mmHg and 4 (SED 2) mmHg) and a decrease in heart rate (P< 0.005), but forearm vasoconstriction was not altered. In the control group, however, forearm vasoconstriction increased during 40 minutes in theatre (P<0.05). Recovery from propofol was far more rapid than after midazolam and was virtually complete in ten minutes. This was reflected by an increase in blood pressure and in forearm vasoconstriction in the recovery period.

scholarly journals Intravenous Sedation in Arnold-Chiari Malformation With Respiratory Failure

2019 ◽  
Vol 66 (1) ◽  
pp. 37-41 ◽  
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.

scholarly journals Anesthetic Management of a Patient With Hereditary Angioedema for Oral Surgery

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.

scholarly journals Management of gag reflex for patients undergoing dental treatment

2019 ◽  
Author(s):  
Prashanti Eachempati ◽  
Sumanth Kumbargere Nagraj ◽  
Salian Kiran Kumar Krishanappa ◽  
Renjith P George ◽  
Htoo Htoo Kyaw Soe ◽  
...  
Keyword(s):  
Dental Treatment ◽  
Gag Reflex
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