Predictors of hypoxemia during moderate sedation for periodontal surgery: a series of 2,221 sedations.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.