Masuda Rikuo, Nonaka Mutsumi, Nishimura Akiko, Gotoh Kinuko, Oka Shuichirou, Iijima Takehiko
Department of Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, Japan.
PLoS One. 2017 Feb 9;12(2):e0171627. doi: 10.1371/journal.pone.0171627. eCollection 2017.
The incidences of morbidity and mortality caused by pharmacosedation for dental treatment have not yet reached zero. Adverse events are related to inappropriate respiratory management, mostly originating from an overdose of sedatives. Since sedation is utilized for the satisfaction of both the dentist and the patient, the optimal dose should be minimized to prevent adverse events. We attempted to define the optimal doses of midazolam and propofol required to achieve high levels of patient and dentist satisfaction.
One thousand dental patients, including those undergoing third molar extractions, were enrolled in this study. A dose of 1 mg of midazolam was administered at 1-minute intervals until adequate sedation was achieved. Propofol was then infused continuously to maintain the sedation level. Both the patients and the dentists were subsequently interviewed and asked to complete a questionnaire. A multivariate logistic regression analysis was used to examine the factors that contributed to patient and dentist satisfaction.
The peak midazolam dose resulting in the highest percentage of patient satisfaction was 3 mg. Both a lower dose and a higher dose reduced patient satisfaction. Patient satisfaction increased with an increasing dosage of propofol up until 4 mg/kg/hr, reaching a peak of 78.6%. The peak midazolam dose resulting in the highest percentage of dentist satisfaction (78.8%) was 2 mg. Incremental propofol doses reduced dentist satisfaction, in contrast to their effect on patient satisfaction. The strongest independent predictors of patient satisfaction and dentist satisfaction were no intraoperative memory (OR, 5.073; 95% CI, 3.532-7.287; P<0.001) and unintentional movements by the patient (OR, 0.035; 95% CI, 0.012-0.104; P<0.001), respectively. No serious adverse events were reported.
We found that 3 mg of midazolam and 3 mg/kg/hr of propofol may be the optimal doses for maximizing both patient and dentist satisfaction. Although this level of sedation is relatively light, memory loss and an absence of unintentional patient movements can be expected without adverse events.
牙科治疗药物镇静导致的发病率和死亡率尚未降至零。不良事件与不当的呼吸管理有关，主要源于镇静剂过量。由于镇静是为了满足牙医和患者双方的需求，应尽量减少最佳剂量以预防不良事件。我们试图确定达到高水平患者和牙医满意度所需的咪达唑仑和丙泊酚的最佳剂量。
本研究纳入了1000名牙科患者，包括接受第三磨牙拔除术的患者。每隔1分钟给予1毫克咪达唑仑，直至达到充分镇静。然后持续输注丙泊酚以维持镇静水平。随后对患者和牙医进行访谈，并要求他们填写问卷。采用多因素逻辑回归分析来检查影响患者和牙医满意度的因素。
导致患者满意度最高百分比的咪达唑仑峰值剂量为3毫克。较低剂量和较高剂量均会降低患者满意度。丙泊酚剂量增加至4毫克/千克/小时时患者满意度提高，达到峰值78.6%。导致牙医满意度最高百分比（78.8%）的咪达唑仑峰值剂量为2毫克。与对患者满意度的影响相反，丙泊酚剂量增加会降低牙医满意度。患者满意度和牙医满意度的最强独立预测因素分别是术中无记忆（OR，5.073；95%CI，3.532 - 7.287；P<0.001）和患者无无意识动作（OR，0.035；95%CI，0.012 - 0.104；P<0.001）。未报告严重不良事件。
我们发现3毫克咪达唑仑和3毫克/千克/小时的丙泊酚可能是使患者和牙医满意度最大化的最佳剂量。尽管这种镇静水平相对较轻，但可以预期无不良事件发生且能实现记忆丧失和患者无无意识动作。
