Kaufman E, Davidson E, Sheinkman Z, Magora F
Hospital Oral Medicine Service, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
J Oral Maxillofac Surg. 1994 Aug;52(8):840-3; discussion 844. doi: 10.1016/0278-2391(94)90232-1.
Two new modes of sedation; patient-controlled sedation (PCS) and intranasal sedation (INS) were compared with the traditional bolus intravenous sedation (BIVS) while delivering dental care to apprehensive patients in a specialized dental fear clinic. Effective sedation was evaluated in a randomized, prospective study in 42 ASA 1 and 2 patients, in a factorial design. Eighteen patients were sedated with .5% midazolam INS. Ten patients received intravenous PCS via a patient-controlled analgesia pump containing midazolam, and 14 patients received intermittent intravenous boluses of 1 mg midazolam given as needed (BIVS). Appropriate local anesthetic nerve blocks with 2% lidocaine with 1:100,000 epinephrine, and supplementary inhalation of nitrous oxide and oxygen via a nasal mask, were also given to all patients in the study. The dosage requirement with PCS was higher than that found with INS or BIVS. However, PCS produced some anxiety reduction when compared with INS and BIVS. It also reduced interfering movements during treatment more effectively than the other sedation modes. No complications were detected in any of the patients and they were able to leave the clinic within 1 hour after completion of treatment.
在一家专门的牙科恐惧症诊所为焦虑患者提供牙科护理时，将两种新的镇静方式，即患者自控镇静（PCS）和鼻内镇静（INS）与传统的静脉推注镇静（BIVS）进行了比较。在一项针对42例ASA 1级和2级患者的随机前瞻性研究中，采用析因设计对有效镇静进行了评估。18例患者接受0.5%咪达唑仑鼻内镇静。10例患者通过含有咪达唑仑的患者自控镇痛泵接受静脉PCS，14例患者按需接受1 mg咪达唑仑的间歇性静脉推注（BIVS）。研究中的所有患者还接受了含1:100,000肾上腺素的2%利多卡因适当的局部麻醉神经阻滞，并通过鼻罩辅助吸入一氧化二氮和氧气。PCS的剂量需求高于INS或BIVS。然而，与INS和BIVS相比，PCS能减轻一些焦虑。与其他镇静方式相比，它还能更有效地减少治疗过程中的干扰性动作。所有患者均未检测到并发症，且在治疗完成后1小时内能够离开诊所。
