Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
Aust Dent J. 2011 Sep;56(3):296-301. doi: 10.1111/j.1834-7819.2011.01350.x.
The aim of this study was to evaluate the use of inhaled methoxyflurane (Penthrox) in the reduction of dental anxiety in patients undergoing mandibular third molar removal in a specialist surgical suite and compare it to the conventional nitrous oxide sedation.
A prospective randomized, non-blinded crossover design study of 20 patients receiving two types of sedation for their third molar extraction who participated in 40 treatment sessions. At first appointment, a patient was randomly assigned to receive either nitrous oxide sedation or intermittent Penthrox inhaler sedation, with the alternate regimen administered during the second appointment. Peri-procedural vital signs (heart rate and blood pressure) were recorded and any deviations from 20% from the baseline values, as well as any drop in oxygen saturation below 92% were documented. The Ramsay Sedation Scale (RSS) score was recorded every five minutes. Patient cooperation during the procedure, patients' general opinion about the sedation technique, surgeon satisfaction and the occurrence of side effects were all recorded. After the second procedure, the patient was also asked if he or she had any preference of one sedation technique over the other.
Levels of sedation were comparable in nitrous oxide and Penthrox sedation sessions. However, at 15 minutes of sedation it was significantly lighter (p < 0.05) in Penthrox. No patient in both regimens reached a RSS deeper than a score of 4. Parameters measured for assessment of sedation (patient cooperation, surgeon satisfaction and patient general opinion about sedation technique) were all similarly comparable for both nitrous oxide and Penthrox. In both sedation sessions, the odour of the inhalational agent was accepted by the patients; half of the patients (10 patients) who received methoxyflurane thought its odour was pleasant. Patients preferred methoxyflurane (Penthrox) inhalation over nitrous oxide sedation (Fisher's Exact test, p < 0.05). Adverse events were minimal. No patient was either deeply sedated or agitated. Blood pressure was within ± 20% from the baseline values. No patient had oxygen saturation less than 92%. Dizziness was the most frequently encountered side effect in both regimens (four patients each). Two patients had bradycardia (HR < 60 beats/minute) when nitrous oxide was used in comparison to one patient with Penthrox sedation. Paraesthesia of fingers and heaviness of the chest was encountered only with nitrous oxide sedation (four patients). Mild self-limited shivering occurred in one patient with Penthrox sedation.
The Penthrox Inhaler can produce a comparable sedation to that of nitrous oxide for the surgical extraction of third molars under local anaesthesia.
本研究旨在评估吸入甲氧氟烷（Penthrox）在专科手术套房中进行下颌第三磨牙拔除时减轻牙科焦虑症的效果，并与常规笑气镇静进行比较。
对 20 名接受两种镇静方式进行第三磨牙拔除的患者进行前瞻性随机、非盲交叉设计研究，每位患者接受 40 次治疗。在第一次就诊时，患者随机分配接受笑气镇静或间歇性 Penthrox 吸入镇静，第二次就诊时给予另一种方案。记录围手术期生命体征（心率和血压），记录任何偏离基线值 20%的情况，以及任何血氧饱和度降至 92%以下的情况。每 5 分钟记录 Ramsay 镇静评分（RSS）。记录患者在手术过程中的合作程度、患者对镇静技术的总体意见、外科医生满意度以及不良反应的发生情况。第二次手术后，还询问患者是否对一种镇静技术有偏好。
笑气和 Penthrox 镇静组的镇静水平相当。然而，在镇静 15 分钟时，Penthrox 组的镇静水平显著较轻（p<0.05）。两种方案中均无患者达到 RSS 评分超过 4 分。用于评估镇静的参数（患者合作、外科医生满意度和患者对镇静技术的总体意见）在笑气和 Penthrox 组均相似。在两种镇静方案中，吸入剂的气味均被患者接受；接受甲氧氟烷的患者中有一半（10 名患者）认为其气味宜人。患者更喜欢甲氧氟烷（Penthrox）吸入而非笑气镇静（Fisher 确切检验，p<0.05）。不良反应很少。无患者镇静过深或烦躁不安。血压在基线值的±20%范围内。无患者血氧饱和度低于 92%。头晕是两种方案中最常遇到的不良反应（各 4 例）。与使用 Penthrox 镇静的患者相比，使用笑气时，有 2 名患者出现心动过缓（HR<60 次/分钟），而使用 Penthrox 镇静的患者有 1 名出现心动过缓。仅在使用笑气镇静时，4 名患者出现手指感觉异常和胸部沉重感。1 名接受 Penthrox 镇静的患者出现轻度自限性颤抖。
Penthrox 吸入器可产生与笑气相似的镇静效果，用于局部麻醉下第三磨牙的外科拔除。
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