Averley P A, Girdler N M, Bond S, Steen N, Steele J
Principle Dentist, Queensway Anxiety Management Clinic, 170 Queensway, Billingham, UK.
Anaesthesia. 2004 Sep;59(9):844-52. doi: 10.1111/j.1365-2044.2004.03805.x.
Failure of dental treatment due to anxiety is a common problem in children. The aim of this study was to establish whether the use of a combination of intravenous midazolam with inhalation agents (nitrous oxide alone or in combination with sevoflurane) was any more likely to result in successful completion of treatment than midazolam alone. A further aim was to evaluate the clinical viability of these techniques as an alternative to general anaesthesia. In total, 697 children too anxious for management with relative analgesia and requiring invasive dental procedure for which a general anaesthetic would usually be required, were recruited and randomly assigned to one of three groups given the following interventions: group 1 - a combination of inhaled medical air and titrated intravenous midazolam, group 2 - a combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam, and group 3 - a combination of an inhaled mixture of sevoflurane 0.3% and nitrous oxide 40% in oxygen with titrated intravenous midazolam. The primary outcome measure was successful completion of the intended dental treatment with a co-operative child responsive to verbal commands. In group 1, 54% (94/174 children) successfully completed treatment. In group 2, 80% (204/256 children) and in group 3, 93% (249/267 children) completed treatment. This difference was significant at the 1% level. Intravenous midazolam, especially in combination with inhaled nitrous oxide or sevoflurane and nitrous oxide, are effective techniques, with the combination of midazolam and sevoflurane the one most likely to result in successful treatment.
因焦虑导致牙科治疗失败是儿童中常见的问题。本研究的目的是确定静脉注射咪达唑仑与吸入剂（单独使用氧化亚氮或与七氟醚联合使用）联合使用是否比单独使用咪达唑仑更有可能成功完成治疗。另一个目的是评估这些技术作为全身麻醉替代方法的临床可行性。总共招募了697名因焦虑而无法采用相对镇痛法治疗且需要进行通常需要全身麻醉的侵入性牙科手术的儿童，并将他们随机分配到接受以下干预措施的三组中的一组：第1组 - 吸入医用空气与滴定静脉注射咪达唑仑联合使用；第2组 - 吸入40%氧气和氧化亚氮与滴定静脉注射咪达唑仑联合使用；第3组 - 吸入0.3%七氟醚和40%氧化亚氮的氧气混合物与滴定静脉注射咪达唑仑联合使用。主要结局指标是在接受言语指令时有反应的合作儿童成功完成预期的牙科治疗。在第1组中，54%（174名儿童中的94名）成功完成治疗。在第2组中，80%（256名儿童中的204名），在第3组中，93%（267名儿童中的249名）完成治疗。这种差异在1%水平上具有显著性。静脉注射咪达唑仑，尤其是与吸入氧化亚氮或七氟醚和氧化亚氮联合使用时，是有效的技术，其中咪达唑仑与七氟醚联合使用最有可能导致治疗成功。
