Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy.
Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy.
Int J Environ Res Public Health. 2023 Jan 18;20(3):1779. doi: 10.3390/ijerph20031779.
This systematic review and meta-analysis was aimed to investigate the conscious sedation efficiency in patients with intellectual disability undergoing dental treatment (PROSPERO CRD42022344292). Four scientific databases were searched by ad-hoc prepared strings. The literature search yielded 731 papers: 426 were selected, 42 were obtained in full-text format, and 4 more were added after hand searching. Fourteen studies were finally included, 11 of which were included in the meta-analysis (random effect model). A high heterogeneity in the drugs used and route of administration was retrieved. Success rate, occurrence of side effects, and deep sedation occurrence were combined to give an overall efficiency of each drug. NO/O reported the highest efficiency (effect size = 0.90; < 0.01) and proved to be more efficient when used alone. Nine papers reported a success rate of sedation of 80% or more. The prevalence of side effects (6 studies) ranged from 3% to 40%. Enteral and parenteral benzodiazepines showed the same overall efficiency (effect size = 0.86). No meta-analysis has yet been conducted to define the most effective and safest way to achieve conscious sedation in patients with intellectual disability; nitrous oxide appears to be the best choice to perform conscious sedation in patients with intellectual disability undergoing dental treatment.
这是一项系统评价和荟萃分析，旨在研究智力障碍患者在接受牙科治疗时的镇静效果（PROSPERO CRD42022344292）。通过专门编制的字符串在四个科学数据库中进行了文献检索。文献检索共产生了 731 篇论文：其中 426 篇被选择，42 篇获得全文，另外 4 篇通过手动检索获得。最终纳入了 14 项研究，其中 11 项纳入了荟萃分析（随机效应模型）。研究中使用的药物和给药途径存在高度异质性。将成功率、副作用发生情况和深度镇静发生情况结合起来，得出每种药物的总体效率。NO/O 报告的效率最高（效应大小=0.90；<0.01），且单独使用时效率更高。有 9 篇文献报告镇静成功率达到 80%或以上。副作用的发生率（6 项研究）范围为 3%至 40%。肠内和胃肠外苯二氮䓬类药物的总体效率相同（效应大小=0.86）。目前尚无荟萃分析来定义在智力障碍患者中实现清醒镇静的最有效和最安全的方法；一氧化二氮似乎是在接受牙科治疗的智力障碍患者中进行清醒镇静的最佳选择。
