Continuous transcutaneous O2 and CO2 monitoring during conscious sedation for oral surgery

Continuous transcutaneous oxygen and carbon dioxide monitoring during conscious sedation using diazepam, fentanyl, and methohexital indicates that hypoxia occurs in all patients maintained on room air; 36% of the patients maintained on room air showed a decrease in transcutaneous oxygen of greater than 20 mg Hg. Although the use of supplemental O2 prevented hypoxia, the combination of diazepam, fentanyl, and methohexital depressed all of the patient's carbon dioxide chemoreceptors, resulting in a rise in carbon dioxide in the oxygen-supplemented patients as well as in the patients who were maintained on room air. The need for supplemental oxygen in patients sedated with diazepam, fentanyl, and methohexital is clearly established.     

Effects of intravenous midazolam and diazepam on patient response, percentage of oxygen saturation, and hemodynamic factors during periodontal surgery

BACKGROUND: The purpose of this double-masked study was to evaluate effects of intravenous sedation (IVS) using midazolam or diazepam during periodontal procedures on patient recall, psychomotor response, oxygen saturation, and hemodynamic factors. METHODS: Seventeen patients received either two or three scheduled periodontal surgeries under IVS with midazolam, diazepam, or placebo control. Patients were monitored throughout the procedure for hemodynamic variables, percent oxygen saturation, level of recall of common objects presented at baseline, and psychomotor function via the perceptual speed test (PST). RESULTS: Fifteen patients completed the study with average titrated dosages of 3.3 and 12.1 mg for midazolam and diazepam, respectively. Within the limitations of the study, there were few differences observed between the drugs with regard to hemodynamic variables, oxygen saturation, and overall percentage of objects recalled by patients sedated with either drug. However, midazolam was found to cause a greater incidence of amnesia lasting up to 30 minutes when compared to placebo. Patients on diazepam required an average of 15 minutes longer to recover accuracy as measured by the PST. CONCLUSIONS: The results suggest that diazepam and midazolam each may have advantages for IVS. In procedures lasting over 45 minutes, diazepam appears to be more clinically advantageous including a wider margin of safety during titration and gradual recovery. Midazolam may be used for shorter procedures for faster onset of action, predictable amnesic effects, and relatively rapid recovery.     

Incidence of hypoxemia in the postanesthetic recovery room in patients having undergone intravenous sedation for outpatient oral surgery

This study prospectively quantitated the incidence of hypoxia in outpatients in a postanesthetic recovery unit following intravenous (IV) sedation. After identifying the high incidence of hypoxia by the use of pulse oximetry, supplemental oxygen was given to another group of patients and the incidence of the hypoxia was again monitored. Twenty of 100 patients experienced hypoxic episodes in the postanesthetic recovery unit when no supplemental oxygen was administered; only 3 of an additional 100 patients who received supplemental oxygen had episodes of hypoxia. The difference between the groups receiving and not receiving supplemental oxygen was both clinically and statistically significant. As result of this study, the use of supplemental oxygen is recommended for all patients undergoing IV sedation for outpatient oral surgery.     

A comparison of chloral hydrate and diazepam sedation in young children

The purpose of this study was to compare a high and low dose of diazepam with chloral hydrate in the sedation of young children. Thirty healthy children between the ages of 20 and 48 months, with a mean age of 33.5 months, participated in the study. All children exhibited negative behavior during a screening visit and required at least two restorative appointments with the use of sedation. A dose of either 0.3 mg/kg or 0.6 mg/kg of diazepam at one visit and 50 mg/kg of chloral hydrate at another visit was administered in a double-blind manner. All children were restrained in a Papoose Board with auxiliary head restraint and received 50% nitrous oxide/oxygen during treatment. The degree of sleep, body movement, crying, pulse rate, respiratory rate, and blood oxygen saturation were monitored before and during the operative procedures. Vital signs remained essentially unchanged during treatment, except for transitory elevations of the pulse during periods of stimulation. There were no statistically significant differences among the three drug regimens with regard to movement and crying. Significantly more patients who received chloral hydrate were asleep than when either dose of diazepam was given during the first 60 min of treatment. The only side effect found was vomiting in one patient with both chloral hydrate and diazepam. It is concluded that the sedative effects of chloral hydrate and diazepam are similar when young children are sedated for dental treatment. The use of diazepam might be more advantageous because chloral hydrate produces more sleep during the first hour of treatment.     

Midazolam, diazepam, and placebo as intravenous sedatives for dental surgery

This study was a comparison of the sedative and amnestic properties of midazolam and diazepam when administered for relief of patient discomfort during dental surgery. It was a double-blind placebo-controlled group study, which entailed the analysis of 60 patients randomly assigned to the three groups: midazolam, diazepam, and placebo. There were 20 patients in each group. Midazolam patients showed superior performance in the parameters of sedation and amnesia when compared to patients who were administered diazepam. Both groups showed better results than the placebo group, which had the best results with the Digit Symbol Substitution Test and the Trieger Test.     

Comparison of various physiologic and psychomotor parameters in patients sedated with intravenous lorazepam, diazepam, or midazolam during oral surgery

Intravenously administered lorazepam (0.05 mg/kg), diazepam (0.25 mg/kg), and midazolam (0.1 mg/kg) were compared for sedation during oral surgery under local anesthesia. Sixty patients were randomly allocated into three groups in this double-blind, parallel study. The results from this trial show that all three drugs provide satisfactory sedation. Average mean arterial pressures, however, decreased significantly with midazolam and diazepam. Statistically significantly higher heart rates during the entire procedure were also found for lorazepam when compared with diazepam and midazolam. At the postblock stage, the midazolam group had respiratory rates that were significantly higher than those of the other two drug groups. Patients in the diazepam and midazolam groups took significantly longer to complete the pegboard test at the preblock stage than those in the lorzepam group. At 1, 1.5, and 2 hours after arrival in the recovery room, an inversion of groups took place, with the lorazepam group taking significantly longer for their tests than the other two groups. Significantly more improvement in anxiety levels was found at 10 minutes postdrug for the patients who had received diazepam and this tended to remain so on arrival in the recovery room. When compared with the other two groups, significantly more patients in the lorazepam group reported giddiness/dizziness and significantly more in the diazepam group reported pain on injection.     

Comparison of the effectiveness of oral diazepam and midazolam for the sedation of autistic patients during dental treatment

PURPOSE: This study was undertaken to compare the effectiveness of oral diazepam and midazolam in sedating autistic patients during dental treatment. METHODS: The treatment regimen consisted of nitrous oxide/oxygen inhalation in conjunction with oral administration of either diazepam 0.3 mg/kg or midazolam 0.5 mg/kg in a cross-over design study of 13 subjects aged 5.8 to 14.7 years. A drug was classified as being effective when over 70% of the patients taking the drug were judged as "success" in all 3 behavioral criteria: (1) sleeping; (2) body movement; and (3) crying behaviors. The study was observed by an independent clinician with an intraexaminer reliability of 88%. RESULTS: For sleeping behavior, midazolam was found to be significantly more effective than diazepam as the duration of stimulation increased (P<.05). For the movement and crying behaviors, midazolam also proved to be significantly more effective from the start of treatment through the 35- and 40-min markers, respectively (P<.05). For the remainder of treatment, however, there was no statistically significant difference in these behaviors between the trials (P>.05). Diazepam and midazolam were rated as 77% and 100% successful, according to the overall behavior evaluation criteria (P=.02). CONCLUSIONS: Both diazepam and midazolam were shown to be effective sedative agents, successfully and safely used to sedate autistic patients for dental treatment. Midazolam was significantly more effective than diazepam in those portions of the procedure with increased stimulation.     

A preliminary study on oxygen saturation levels of patients during periodontal surgery with and without oral conscious sedation using diazepam

BACKGROUND: Stress and anxiety alter respiratory rate and thereby alter oxygen saturation in the blood. Management of psychological stress in the dental office may help maintain blood gas homeostasis. One method of stress management is through the use of preoperative oral sedation. METHODS: The study population consisted of 13 patients scheduled to receive two quadrants of periodontal surgery at two different appointments. A randomized split-mouth crossover design was used with one quadrant of surgery involving preoperative oral sedation (diazepam) and local anesthetic, and the second using local anesthetic only. Oxygen saturation was monitored by pulse oximetry, which recorded the number of times saturation dropped below 95% in a given time period. Data were recorded at 5 time periods: 1) baseline; 2) from time of anesthetic administration to 20 minutes into surgery; 3) 21 to 40 minutes; 4) 41 to 60 minutes; and 5) 61 to 80 minutes into the surgery. Data were analyzed by a two-factor repeated measures ANOVA. The two within-group factors were treatment group and time. RESULTS: Results indicated no significant interaction between time and treatment (P > .05). However, data for groups over time suggested a trend supporting an interaction. The eta2 value of 0.124 suggested a moderate effect favoring the diazepam treatment. No significant difference was noted for the main effect of treatment and time. However, the eta2 value of 0.24 for treatment effect (diazepam versus no diazepam) suggested a meaningful difference between groups. Similarly the eta2 value of 0.135 for time suggested a moderate effect over time within-subjects. CONCLUSIONS: This study indicates that diazepam given orally in adult dosages does not cause significant respiratory depression, and is generally safe for those healthy patients who may require slight to mild sedation during periodontal surgery.     

Oxygen saturation during third molar removal with local anaesthetic alone and in combination with intravenous sedation

Oxygen saturation was recorded in 96 adults undergoing removal of third molar teeth in the dental surgery. Half the patients received local anaesthetic alone; the remainder received, in addition, intravenous midazolam. Patients receiving sedation sustained the greatest falls in oxygen saturation. However, in 10 out of 48 patients undergoing third molar removal with LA alone, oxygen saturations in the range of 93-89% were recorded. The results of this study suggest that all patients undergoing removal of third molars are at risk of hypoxia. Short episodes of hypoxia may be of little consequence in healthy patients, but in compromised patients early detection may avoid serious complications.     

Evaluation by thoracic impedance cardiography of diazepam, placebo, and two drug combinations for intravenous sedation of dental outpatients

The cardiovascular and respiratory effects of three common intravenous premedicants were examined noninvasively in a population of 20 dental outpatients scheduled for surgical removal of third-molars. Two third molars from one side of the mouth were removed at each appointment. Group 1 received a diazepam titration (mean dose = 25.6 mgs) at one appointment and placebo at the other appointment. Group 2 received a combination of diazepam (12.5 mg), fentanyl (0.1 mg), and methohexital (mean dose = 18.0 mg) at one appointment and the combination of diazepam (15.0 mg) and methohexital (mean dose = 27.0 mg) at the other appointment. Noninvasive measurement of cardiac output revealed little change during intravenous drug administration, but a significant increase was seen in all groups following local anesthesia and during surgery. Heart rate was elevated and stroke volume decreased during administration of the two-drug combinations. Oxygen saturation was greatly decreased following the combination of diazepam, fentanyl, and methohexital. These findings indicate that the combination of diazepam, fentanyl, and methohexital results in decreased oxygen saturation, a transient decrease in stroke volume, and an elevated heart rate when used as an intravenous premedicant for dental outpatients.     

Continuous transcutaneous oxygen tension monitoring during ultralight general anesthesia for oral surgery

The application of continuous, noninvasive, transcutaneous oxygen tension monitoring during ultralight general anesthesia is investigated. Transcutaneous PO₂ measurements showed a high correlation to simultaneously measured arterial PO₂. Significant hypoxia was observed in patients maintained on only room air during ultralight general anesthesia. In patients receiving supplemental oxygen by nasal mask, hyperoxic levels were noted throughout anesthesia, providing a significant margin of safety from hypoxia during periods of apnea or respiratory impairment.     

高血压拔牙患者控制性降压的随机双盲临床研究

目的: 比较高血压患者拔牙术前口服不同药物控制性降压前、后血压和心率的变化,探讨有效控制患者围术期血压的用药方法。方法：对90例高血压拔牙患者随机使用不同药物,即安定、硝苯地平或安定及硝苯地平联合应用,术前进行药物控制性降压,记录拔牙前、后血压、心率变化,采用SPSS17.0软件包,对不同药物的降压效果及拔牙复杂程度、拔牙时间对血压、心率的影响分别进行t检验和χ²检验。结果：经药物控制性降压后,高血压患者拔牙期间血压、心率较平稳,安定与硝苯地平联合应用的降压有效率最高(96.7%)。拔牙难度和拔牙时间对单纯应用安定及安定与硝苯地平联合应用组患者拔牙期血压的变化影响较小,而对单纯应用硝苯地平组患者影响大,但对各组心率均无显著影响。结论：术前药物控制性降压能够达到良好的降压效果,联合用药能更好地提高高血压患者拔牙的安全性。     

Behavioral influences of rectal diazepam in solution on dental patients with mentally and physically handicapping conditions

The hypothesis of this study was to determine whether the use of rectal diazepam in solution would effectively modify the uncooperative behavior of patients with mentally and physically handicapping conditions during dental treatment. The sample consisted of 42 patients with mild to severe mentally handicapping conditions, 4 to 31 years old, who live in a homecare center. Supragingival and subgingival scaling and prophylaxis were attempted during a 5-minute period and the patient's behavior was assessed. Conscious sedation using a rectal solution of diazepam (Stesolid) was used for those patients with voluntary or involuntary uncooperative behavior that prevented treatment. Twenty-two subjects (52.4%) were treated without diazepam. The rectal solution of diazepam proved to be a significantly (P < .01) effective agent for behavior modification permitting the successful treatment of 16 (80%) of the 20 remaining subjects. The following behaviors were significantly modified: places hand(s) or arm(s) in front of mouth (P < .01); does not open mouth, lips held firmly together (P < 05); turns head to one side or side to side (P < 05); attempts to grab instruments (P < .05). No relationship was found between the results and the variables of medical history, gender, age, weight, quantity of diazepam administered, routine medication, pulse rate, blood pressure, and respiration.     

Subanesthetic doses of ketamine,diazepam, and nitrous oxide for adult outpatient sedation

The use of ketamine in adults has been complicated by untoward hallucinatory emergence reactions. The addition of nitrous oxide and diazepam to subanesthetic doses of ketamine may be effective in decreasing these reactions. Adult patients were sedated for outpatient oral and maxillofacial surgery procedures using nitrous oxide, diazepam, and either fentanyl or ketamine. Postoperative questionnaires were used to evaluate hallucinatory reactions, amnesia, and patient acceptance. Comparison of the results of patients receiving ketamine and those receiving fentanyl revealed no statistical differences in hallucinatory reactions or patient acceptance. Amnesia was more complete in the ketamine than the fentanyl group.     

Comparison of sublingual lorazepam with intramuscular diazepam as sedatives during oral surgery

Sublingual lorazepam (2 to 3 mg) was compared with intramuscular diazepam (0.25 mg/kg) and placebo for sedation during oral surgery under local anesthesia. Sixty patients were randomly allocated into three groups in this double-blind, parallel study. The results from this trial show that sublingually administered lorazepam provided good sedation and anxiolysis. More side-effects, such as giddiness, dizziness, and ptosis, as well as profound and prolonged psychomotor impairment, were, however, found in the lorazepam group than in those patients who had received intramuscular diazepam (0.25 mg/kg) or placebo.     

Diazepam (valium) in premedication. Experimental findings

The anxiolytic and analgesic effects of 10 mg of orally administered diazepam (Valium) were assessed on 10 volunteers. The electrodermal activity was recorded during two experimental sessions while cutaneous electrical stimulations were administered to the subjects. On one hand, the anxiolytic activity of diazepam could be observed by a decrease of both autonomic nervous system and anticipatory activities. On the other hand, an increase of the pain threshold could be shown under diazepam by lower responses to the stimulations. These results confirm that diazepam can be useful in anxious patients undergoing dental procedures.     

Prolonged recovery after intravenous diazepam

Prolonged recovery from intravenous diazepam after the day of administration has been examined in 2,468 consecutive patients who underwent oral surgery and general dentistry. Patients ranged in age from 2 to 94 years and received a mean diazepam dose of 19 mg, either by itself or with small amounts of methohexital sodium. Recovery was assessed by use of a questionnaire, and the answers were related to sexual gender, age, weight, dosage, procedure, duration, level of apprehension, and results of the sedation.     

缺氧对人牙周膜成纤维细胞增殖和超微结构影响的实验研究

目的:体外培养人牙周膜成纤维细胞(HPLFS),观察缺氧对其生长增殖能力的影响.方法: 分离培养 HPLFS,随机分为 21% O2对照组和10%、5%、2% O2缺氧组,采用四唑盐(MTT)比色法检测 HPLFS增殖情况,透射电镜下观察细胞超微结构改变.结果:MTT 法检测,与对照组比,12 h、24 h,缺氧对细胞增殖随缺氧程度呈依赖性增强,但重度缺氧(2% O2)24 h组具有统计学差异;48 h、72 h,重度缺氧组细胞增殖与对照组相比明显降低,差别具有统计学意义.透射电镜下,重度缺氧24 h细胞胞质内粗面内质网和线粒体明显增多,细胞突起增多;72 h细胞发生退变,溶酶体增多.结论:长期重度缺氧条件下,牙周膜的改建和修复功能降低,可能是高原牙周疾病多发、牙周组织破坏较重的重要原因.     

Comparison of sedation,amnesia, and patient comfort produced by intravenous and rectal diazepam

In a cross-over study, intravenous diazepam was compared with rectal diazepam for sedation in outpatient oral surgery. Fifty-four operations were performed on 27 patients. Recovery from sedation, experience during the postoperative course, amnesia, estimation of the sedative effect, and patient preference of method of sedation were studied. The recovery times of the sedation methods did not differ. Sedative effects after the first operation were estimated as good by 87% of patients given intravenous sedation and by 75% of those given rectal sedation. However, there was a significant relationship between the subjective experience of stronger sedative effect and preference of sedation method that favored the intravenous technique. The degree of amnesia was significantly higher during intravenous sedation, but a high degree of amnesia was not related to patients' preference for a sedation method. Neither sedation method produced any local side effects.     

A comparison of two sedative premedications for minor oral surgery under local anaesthesia

Two commonly used drug combinations were studied as premedications before surgical 3rd molar removal under local anaesthesia. The study was randomized, crossover and double-blind in 12 patients. Our routine premedication for lengthy operations, consisting of diazepam 10 mg p.o. plus i.m. scopolamine 0.006 mg/kg and morphine 0.2 mg/kg, was compared with a combination of diazepam 10 mg p.o. plus metoprolol 50 mg p.o. The latter combination was expected to cause fewer central nervous system side effects and be more suitable for out-patient surgery. Drug levels in blood, physiological and biochemical indicators of operation-related stress, CNS side effects, and the patients' subjective preferences were monitored. Both combinations were equally accepted by the patients, but the diazepam/scopolamine/morphine combination caused clearly more side effects after discharge than diazepam/metoprolol. The operation-related haemodynamic changes and plasma catecholamine responses were similar after both premedications.