Koutras Toria L, Cacho Denise M, Harris Chelsea E, Millan Claudia P, Stancoven Brian W, Inouye Kimberly Ann, Lincicum Adam R, Topolski Richard, Johnson Thomas M
Department of Periodontics, Army Postgraduate Dental School, Fort Eisenhower, GA, USA.
Department of Psychological Sciences, Augusta University, Augusta, GA, USA.
J Dent Anesth Pain Med. 2025 Aug;25(4):251-262. doi: 10.17245/jdapm.2025.25.4.251. Epub 2025 Jul 23.
Moderate sedation reliably alleviates procedure-related anxiety in dental patients, enabling the comfortable delivery of surgical periodontal therapy. The principal cause of sedation-related morbidity is hypoxemia, secondary to medication-induced hypoventilation and airway obstruction. The objectives of this investigation were to determine the incidence of hypoxemia during moderate sedation for periodontal or implant surgery and to identify statistically significant predictors of hypoxemia.
Records of patients who received moderate sedation for periodontal or dental implant surgery were assessed for hypoxemic events, defined as oxygen saturation ≤ 90%. Binomial logistic regression analysis was conducted to evaluate the influence of patient-, sedation-, and procedure-related variables on the occurrence of hypoxemia.
Records from 2,221 sedations were available for analysis. At least one hypoxemic event occurred in 117 (5.3%) sedations. Only 22 (1.0%) sedations involved more than one event. Age (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.004 - 1.039; P = 0.02) and total midazolam dose (OR: 1.118; 95% CI: 1.024 - 1.220; P = 0.01) were significant predictors of hypoxemia. The association between body mass index and hypoxemia did not reach statistical significance (OR: 1.042; 95% CI: 0.995 - 1.091; P = 0.08).
The incidence of hypoxemia observed in this study was substantially lower than that reported in patients receiving moderate sedation for minor oral/maxillofacial surgery or gastrointestinal endoscopy. Although further research is warranted, it is possible that patients receiving moderate sedation for periodontal or implant surgery are less likely to experience hypoxemia due to smaller total doses of sedatives, titration of sedatives over longer procedure durations, and the greater need for intraoperative patient cooperation.
中度镇静能可靠地减轻牙科患者与手术相关的焦虑，使牙周手术治疗得以舒适地进行。与镇静相关的发病主要原因是低氧血症，继发于药物引起的通气不足和气道阻塞。本研究的目的是确定牙周或种植手术中度镇静期间低氧血症的发生率，并确定低氧血症具有统计学意义的预测因素。
评估接受牙周或牙种植手术中度镇静患者的记录，以确定低氧血症事件（定义为氧饱和度≤90%）。进行二项逻辑回归分析，以评估患者、镇静和手术相关变量对低氧血症发生的影响。
有2221例镇静记录可供分析。117例（5.3%）镇静中至少发生一次低氧血症事件。只有22例（1.0%）镇静涉及不止一次事件。年龄（优势比[OR]：1.022；95%置信区间[CI]：1.004 - 1.039；P = 0.02）和咪达唑仑总剂量（OR：1.118；95%CI：1.024 - 1.220；P = 0.01）是低氧血症的显著预测因素。体重指数与低氧血症之间的关联未达到统计学意义（OR：1.042；95%CI：0.995 - 1.091；P = 0.08）。
本研究中观察到的低氧血症发生率显著低于接受小型口腔/颌面外科手术或胃肠内镜检查中度镇静患者的报告发生率。尽管有必要进行进一步研究，但接受牙周或种植手术中度镇静的患者由于镇静剂总剂量较小、在较长手术时间内滴定镇静剂以及术中对患者合作的更大需求，可能发生低氧血症的可能性较小。
