Jackson Douglass L, Johnson Barton S
Department of Oral Medicine, University of Washington School of Dentistry, B412 Health Sciences Building, Seattle, WA 98195, USA.
Dent Clin North Am. 2002 Oct;46(4):781-802. doi: 10.1016/s0011-8532(02)00029-0.
There are clearly many safe and effective sedatives available to the dental practitioner for reducing patient fear and improving their level of comfort. Careful consideration needs to be given to the objectives of the sedation when deciding which pharmacologic agents to use because they all possess slightly different clinical characteristics and various degrees of risk. Patient selection also is critical when making decisions about sedation because the patient's expectations and general health status factor into keeping the procedure safe. N2O/O2 sedation is an excellent choice for managing the mildly fearful dental patient or when minimal sedation is desirable. Among the sedatives administered enterally, the benzodiazepines are the most commonly used, and for good reason. These drugs are safe, effective, and offer a host of different personalities from which the dentist can choose. If used wisely and thoughtfully, the dentist can tailor the effects and duration of onset and recovery to the needs of the patient and the expected parameters of the appointment. When N2O/O2 sedation is combined with a single enteral sedative, a more profound level of CNS depression is achieved that can be modestly altered by changing the concentration of inhaled nitrous oxide. With these many pharmacologic alternatives, many different dental patient populations can be sedated in a safe, effective manner, thus allowing the delivery of most dental treatments in a setting of reduced psychologic and physiologic stress. These pharmacologic sedatives have truly opened up a wonderful world of possibilities for the comfortable delivery of dental care, and should be integrated into every office's repertoire for delivery of care.
对于牙科医生来说，显然有许多安全有效的镇静剂可用于减轻患者的恐惧并提高他们的舒适度。在决定使用哪种药物制剂时，需要仔细考虑镇静的目标，因为它们都具有略有不同的临床特征和不同程度的风险。在做出镇静决策时，患者的选择也至关重要，因为患者的期望和总体健康状况是确保手术安全的因素。笑气/氧气镇静是管理轻度恐惧的牙科患者或需要最小程度镇静时的绝佳选择。在肠道给药的镇静剂中，苯二氮卓类是最常用的，这是有充分理由的。这些药物安全、有效，并且有许多不同的特性可供牙医选择。如果明智且谨慎地使用，牙医可以根据患者的需求和预期的治疗参数来调整起效和恢复的效果及持续时间。当笑气/氧气镇静与单一肠道镇静剂联合使用时，可以实现更深度的中枢神经系统抑制，通过改变吸入氧化亚氮的浓度可以适度改变这种抑制程度。有了这么多药物选择，可以以安全、有效的方式对许多不同类型的牙科患者进行镇静，从而在心理和生理压力降低的情况下进行大多数牙科治疗。这些药物镇静剂确实为舒适地提供牙科护理开辟了一个美妙的可能性世界，应该纳入每个诊所的护理方法中。
