Dell'Olio Fabio, Capodiferro Saverio, Lorusso Pantaleo, Limongelli Luisa, Tempesta Angela, Massaro Maria, Grasso Salvatore, Favia Gianfranco
Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, ITA.
Emergency Department, University of Bari Aldo Moro, Bari, ITA.
Cureus. 2019 Dec 30;11(12):e6508. doi: 10.7759/cureus.6508.
Aim This study evaluated a protocol of light conscious sedation for multimodal analgesia in patients with a clinical history of acute myocardial infarction requiring tooth extraction and to assess postoperative pain by using the quantity intake of acetaminophen as the indicator. Material and methods All 50 patients received preliminary anxiolysis via oral chlordemethyldiazepam administration. After 15 to 20 minutes, only patients reporting they were not fully relaxed received additional intravenous diazepam before tooth extraction. Acetaminophen 1000 mg was suggested as the preferred postoperative analgesic drug. Results The studied patients included 39 women and 11 men with a mean age of 69.4 ± 17.1 years. They were classified according to the American Society of Anesthesiologists Physical Status classification system as follows: 12 patients belonging to class II, 32 patient to class III, and the remaining six to class IV. Based on the Modified Dental Anxiety Scale, six patients were phobic and seven anxious. Nevertheless, intravenous conscious sedation was needed in 23 patients via diazepam. The first day after surgery, 76% of patients took acetaminophen, and 58% took acetaminophen the second day, with a mean two-day total intake of acetaminophen of 1020 ± 789 mg/day. Stratified statistical analysis was performed and revealed that 60.87% of patients receiving intravenous diazepam needed to take acetaminophen on the first day after dental extraction in contrast to the 88.89% of patients who did not receive intravenous diazepam (χ test; P = .021). Conclusions Our data suggest that anxiety related to dental procedures is widespread, although often unmentioned by patients. Moreover, the percentage of patients needing analgesics during the first 24 hours following surgery demonstrated that overall perioperative pain might be controlled by the light conscious sedation protocol for patients with previous acute myocardial infarction proposed in the current study.
目的 本研究评估了一种轻度清醒镇静方案用于有急性心肌梗死病史且需要拔牙的患者的多模式镇痛，并以对乙酰氨基酚的摄入量作为指标评估术后疼痛情况。材料与方法 所有50例患者均通过口服氯地西泮进行初步抗焦虑治疗。15至20分钟后，仅报告未完全放松的患者在拔牙前额外静脉注射地西泮。建议将1000毫克对乙酰氨基酚作为首选的术后镇痛药。结果 研究患者包括39名女性和11名男性，平均年龄为69.4±17.1岁。根据美国麻醉医师协会身体状况分类系统，他们的分类如下：12例属于II级，32例属于III级，其余6例属于IV级。根据改良牙科焦虑量表，6例患者为恐惧症患者，7例为焦虑症患者。然而，23例患者需要通过地西泮进行静脉清醒镇静。术后第一天，76%的患者服用了对乙酰氨基酚，第二天58%的患者服用了对乙酰氨基酚，对乙酰氨基酚的平均两日总摄入量为1020±789毫克/天。进行分层统计分析后发现，拔牙后第一天，接受静脉注射地西泮的患者中有60.87%需要服用对乙酰氨基酚，而未接受静脉注射地西泮的患者这一比例为88.89%（χ检验；P = 0.021）。结论 我们的数据表明，与牙科手术相关的焦虑很普遍，尽管患者常常未提及。此外，术后24小时内需要镇痛药的患者百分比表明，本研究中提出的针对既往有急性心肌梗死的患者的轻度清醒镇静方案可能可以控制总体围手术期疼痛。
