Shin Dong-Whan, Cho Jin-Yong, Han Yoon-Sic, Sim Hye-Young, Kim Hee-Sun, Jung Da-Un, Lee Ho
Department of Oral and Maxillofacial Surgery, Dankook University Jukjeon Dental Hospital, Yongin, Korea.
Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea.
J Korean Assoc Oral Maxillofac Surg. 2017 Aug;43(4):229-238. doi: 10.5125/jkaoms.2017.43.4.229. Epub 2017 Aug 24.
The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction.
Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer's assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the -value was set at 0.05.
Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; =0.005) and higher dental anxiety (OR, 5.744; =0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; =0.002) and higher BIS right before MDZ administration (OR, 1.379; =0.029) had relevance to patient dissatisfaction.
The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.
本研究的主要目的是调查在使用咪达唑仑（MDZ）进行静脉清醒镇静（IVS）期间与额外给予镇静剂相关的因素。次要目的是分析影响患者满意度的因素。
在这项病例对照研究中，回顾性调查了124例在IVS下使用MDZ进行下颌第三磨牙手术拔除的患者的临床资料。MDZ的初始剂量由体重指数（BMI）和体重确定。如果手术开始时镇静不足，则注射额外剂量。手术期间，监测并记录外周血氧饱和度、脑电双频指数（BIS）评分、心率和血压。预测变量为性别、年龄、BMI、睡眠时间比、牙科焦虑、Pederson量表和MDZ的初始剂量。结果变量为MDZ的额外给药、观察者对清醒/镇静的评估、术中遗忘和患者满意度。计算描述性统计量，P值设定为0.05。
大多数患者仅使用MDZ初始剂量就有足够的镇静水平，并对镇静下的治疗感到满意；然而，19例患者需要额外给药，13例患者不满意。在多变量逻辑分析中，较低年龄（比值比[OR]，0.825；P = 0.005）和较高牙科焦虑（OR，5.744；P = 0.003）与额外给药相关；较低的术中遗忘（OR，0.228；P = 0.002）和MDZ给药前较高的BIS（OR，1.379；P = 0.029）与患者不满意相关。
在IVS下的小型口腔手术中，术前考虑年龄和牙科焦虑对于确定MDZ的合适剂量是必要的。对手术过程的遗忘对患者满意度有积极影响。
