Yamashiro M
Department of Anesthesiology, Nippon Dental University School of Denistry at Tokyo, Japan.
Anesth Prog. 1995;42(3-4):103-6.
These results were all obtained by dental anesthesiologists in our clinic actually conducting conscious sedation while observing the patients' response and appearance. Consequently, the anesthesiologist's preferences and skill seem to influence the drugs chosen and the method of use. In reviewing these 300 cases, we found many in which the procedure was completed within 40 min, and effective sedation could be achieved by intravenous sedation using a single benzodiazepine. When a variety of dental treatments are scheduled, tooth extraction is usually performed last. Since the depth of sedation in such cases has become shallow, carelessly performed local anesthetic injections lead to undesirable results. Aside from the nature and duration of treatment, when sedation was employed because of patients' problems, such as anxiety concerning the procedure, good sedation was often achieved with a benzodiazepine, even for relatively lengthy treatments. When a benzodiazepine failed to achieve good sedation on first administration in patients scheduled for repeated sedation, additional drugs are sometimes required from the second time onward. In patients with a gag reflex, conscious sedation with a benzodiazepine alone, and without a comprehensive sedation plan, often ends in failure, and ultimately high doses of multiple drugs have been used in some patients. In some cases, patient management was impossible without general anesthesia.
这些结果都是由我们诊所的牙科麻醉医生在实际进行清醒镇静的同时观察患者的反应和表现而获得的。因此，麻醉医生的偏好和技能似乎会影响所选用的药物和使用方法。在回顾这300例病例时，我们发现许多病例在40分钟内完成了操作，并且通过单次使用苯二氮䓬类药物进行静脉镇静就能实现有效的镇静效果。当安排了多种牙科治疗时，拔牙通常在最后进行。由于此类情况下镇静深度变浅，局部麻醉注射操作不当会导致不良后果。除了治疗的性质和持续时间外，当因患者的问题（如对操作的焦虑）而采用镇静时，即使是相对较长时间的治疗，使用苯二氮䓬类药物也常常能实现良好的镇静效果。对于计划进行重复镇静的患者，当首次使用苯二氮䓬类药物未能达到良好的镇静效果时，有时从第二次开始就需要额外用药。对于有咽反射的患者，仅使用苯二氮䓬类药物进行清醒镇静且没有全面的镇静计划，往往会以失败告终，最终一些患者使用了高剂量的多种药物。在某些情况下，没有全身麻醉就无法进行患者管理。
