A Prospective Randomized Controlled Trial of Two Different Sedation Sequences for Third Molar Removal in Adults

Khader, Ruba; Oreadi, Daniel; Finkelman, Matthew; Jarmoc, Marcin; Chaudhary, Sanjeet; Schumann, Roman; Rosenberg, Morton

doi:10.1016/j.joms.2014.08.033

Cited by 7 publications

(9 citation statements)

References 12 publications

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“…In dental practice, intravenous anesthesia without tracheal intubation is often used for patients who are difficult to treat due to dental anxiety [1][2][3]. However, since respiratory depression due to airway obstruction can occur in these patients, perioperative respiratory monitoring is very important.…”

Section: Introductionmentioning

confidence: 99%

Acoustic method respiratory rate monitoring is useful in patients under intravenous anesthesia

Ouchi

Fujiwara

Sugiyama

2016

J Clin Monit Comput

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Respiratory depression can occur during intravenous general anesthesia without tracheal intubation. A new acoustic method for respiratory rate monitoring, RRa (Masimo Corp., Tokyo, Japan), has been reported to show good reliability in post-anesthesia care and emergency units. The purpose of this study was to investigate the reliability of the acoustic method for measurement of respiratory rate during intravenous general anesthesia, as compared with capnography. Patients with dental anxiety undergoing dental treatment under intravenous anesthesia without tracheal intubation were enrolled in this study. Respiratory rate was recorded every 30 s using the acoustic method and capnography, and detectability of respiratory rate was investigated for both methods. This study used a cohort study design. In 1953 recorded respiratory rate data points, the number of detected points by the acoustic method (1884, 96.5 %) was significantly higher than that by capnography (1682, 86.1 %) (P < 0.0001). In the intraoperative period, there was a significant difference in the LOA (95 % limits of agreement of correlation between difference and average of the two methods)/ULLOA (under the lower limit of agreement) in terms of use or non-use of a dental air turbine (P < 0.0001). In comparison between capnography, the acoustic method is useful for continuous monitoring of respiratory rate in spontaneously breathing subjects undergoing dental procedures under intravenous general anesthesia. However, the acoustic method might not accurately detect in cases in with dental air turbine.

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Section: Introductionmentioning

confidence: 99%

Acoustic method respiratory rate monitoring is useful in patients under intravenous anesthesia

Ouchi

Fujiwara

Sugiyama

2016

J Clin Monit Comput

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“…Moderate sedation with analgesia (formerly known as "conscious sedation") is the depression of consciousness, during which the patients respond purposefully to verbal commands or with light tactile stimulation. Moderate sedation/analgesia with midazolam and/or fentanyl was prospectively reported to be safe and therefore, the preferred drug choice for not supervised by an anesthetist cases [10][11][12]. While moderate sedation has been widely performed by brachytherapists for intracavitary brachytherapy, there is not much published reports on the use of moderate sedation for interstitial brachytherapy [13].…”

Section: Purposementioning

confidence: 99%

Non-anesthetist-administered moderate sedation with midazolam and fentanyl for outpatient MRI-aided hybrid intracavitary and interstitial brachytherapy in cervix cancer: a single-institution experience

Sommat¹,

Lin²,

Chew³

et al. 2021

jcb

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Purpose:The aim of the study was to determine the feasibility of interstitial brachytherapy under non-anesthetist-administered moderate sedation, to identify factors influencing the insertion, and the total procedural time.Material and methods: A total of 47 insertions with hybrid intracavitary and interstitial applicators were performed in 23 patients from March 2017 to March 2020. Moderate sedation was achieved with intravenous midazolam and fentanyl administered by non-anesthetist. Insertion time and procedural time was recorded. Univariate and multivariate analysis were performed to evaluate the impact of different factors on insertion and procedural time.Results: A total of 238 needles (range, 2-8 per insertion) were implanted, with an average insertion depth of 30 mm (range, 20-40 mm). The mean doses for midazolam and fentanyl were 3 mg (standard deviation [SD] = 1) and 53.3 mcg (SD = 23.9) per insertion, respectively. The median insertion time was 30 minutes (interquartile range [IQR] = 22-40), and the median total procedural time was 4.3 hours (IQR = 3.6-5.2). First time insertion, insertions performed before 2019, and higher midazolam dose were associated with significantly longer insertion time, whereas longer insertion time, MRIbased planning, and insertions performed before 2019 were associated with significantly longer total procedural time.Conclusions: Outpatient interstitial brachytherapy with non-anesthetist-administered sedation is achievable and well-tolerated. This method may significantly lessen the burden on hospital resources and has the potential to be cost-effective.

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“…While maintaining patient responsiveness to verbal and tactile stimuli [ 1 ], safety of conducting moderate sedation in dental clinic is well documented with infrequent complications [ 1 2 ]. Preferred drug choices for administering moderate intravenous (IV) sedation are midazolam (benzodiazepine sedative) and fentanyl (opioid analgesic) because their safety and efficacy have been well established [ 3 4 5 6 7 8 ]. Other drug options for moderate IV sedation exist, but are beyond the scope of this article.…”

Section: Introductionmentioning

confidence: 99%

“…However, the administration order of the sedative/opioid two-drug moderate sedation is not prescribed. In most of North America, the administration order―whether the sedative or the opioid should be administered first―is determined at the discretion of the dentist based on clinician preference and/or assessment of the patient's individual need [ 3 10 ]. For example, if a patient suffers from moderate to high anxiety and reduced anxiety, or recall of the procedure is the patients' expectation, a sedative-first approach may be preferred.…”

Section: Introductionmentioning

confidence: 99%

“…While logical arguments for prescription based on patient need exists, there is limited research or compelling evidence regarding how to prescribe sedative/analgesic administration order in dental sedation. One randomized control trial found no significant effects of fentanyl and midazolam order administration on patient pain, changes in vital signs, or satisfaction [ 3 ]. However, this study held drug dosages constant, whereas in general practice, drugs are typically titrated to effect (i.e., patient comfortable and appropriately responsive), with dosages varying depending on patient characteristics (e.g., anxiety) and procedural stimuli (e.g., complexity of the dental procedure).…”

Section: Introductionmentioning

confidence: 99%

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Administration order of midazolam/fentanyl for moderate dental sedation

Lobb

Clarke

Lai

2018

J Dent Anesth Pain Med

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BackgroundThe purpose of this study is to investigate the effects of administration order when a sedative drug (midazolam) and an opioid analgesic drug (fentanyl) is applied for moderate intravenous (IV) sedation in dentistry.MethodsA retrospective chart review was conducted in one dental clinic during its transition from a midazolam-first to a fentanyl-first protocol for dental procedures requiring moderate IV sedation. Physiological parameters, drug administration times, patient recovery times, drug dosages, and patient recall and satisfaction were investigated for differences.ResultsA total of 76 charts (40 midazolam-first and 36 fentanyl-first administrations), were used in the analysis. Administering midazolam first resulted in an average 4.38 min (52%) decrease in administration times (P < 0.001), and a decrease in procedural recollection immediately following the procedure (P = 0.03), and 24 to 48 hours later (P = 0.009). Administering fentanyl first required an average of 2.43 mg (29%) less midazolam (P < 0.001). No significant differences were found for change in vital signs, minimum oxygen saturation levels, recovery times, and patient satisfaction (P > 0.05). Oxygen saturation levels did not drop below 90% for either group; however, 5 cases in the fentanyl-first group fell to between 90% and 92%, compared with 0 cases in the midazolam-first group.ConclusionsThe administration order of fentanyl and midazolam may have different effects on patients and the sedation procedure. Findings from this study should be used to facilitate discussion among dental practitioners and to guide additional research investigating this topic.

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A Prospective Randomized Controlled Trial of Two Different Sedation Sequences for Third Molar Removal in Adults

Cited by 7 publications

References 12 publications

Acoustic method respiratory rate monitoring is useful in patients under intravenous anesthesia

Acoustic method respiratory rate monitoring is useful in patients under intravenous anesthesia

Non-anesthetist-administered moderate sedation with midazolam and fentanyl for outpatient MRI-aided hybrid intracavitary and interstitial brachytherapy in cervix cancer: a single-institution experience

Administration order of midazolam/fentanyl for moderate dental sedation

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