Analysis of Oxygen Saturations Recorded During Dental Intravenous Sedations: A Retrospective Quality Assurance of 3500 Cases

Abstract

The death of a patient under sedation in New South Wales, Australia, in 2002 has again raised the question of the safety of dental sedation. This study sought answers to 2 questions: Can safe oxygen saturation levels ($94%) be consistently maintained by a single operator/sedationist ? Does the additional use of propofol, in subanesthetic doses, increase the risk of exposure to hypoxemia ? Three thousand five hundred cases generated between 1996 and 2006 were randomly examined and divided into 2 subcohorts: 1750 patients were sedated with midazolam and fentanyl, and 1750 patients received propofol, in subanesthetic increments, in addition to midazolam and fentanyl. Initial sedation was established using midazolam and fentanyl in both subcohorts. The second subcohort received propofol during times of noxious stimulation. Patient exposure to 2 or more oxygen desaturations below 94% was uncommon. The variables that were significantly associated with low saturations were age, gender, and weight. Neither the dose of midazolam nor the additional use of propofol was a significant risk factor. ASA classification ( I or II) was not a determinant of risk. The data, within the limitations of the study, showed that a single operator/sedationist, supported by a well-trained team of nurses, can consistently maintain safe oxygen saturation levels. The additional use of propofol did not increase exposure to hypoxemia.

Intravenous Moderate Sedation as an Adjunct for Periodontal Surgery: A Retrospective Analysis of 964 Cases

“…Concerning respiratory parameters, the current case series found an average intraoperative pulse oxygenation drop of 2.02%. Similarly, intraoperative pulse oxygenation dropped an average of 2.05% in the study by González‐Lemonnier et al 18 These findings are in agreement with a much larger study by Viljoen et al, 19 who evaluated oxygen saturation levels in 3,500 dental conscious‐sedation cases. The results of their study found that some patients had pulse oxygenation values drop below 94% and concluded that “a single operator/sedationist, supported by a well‐trained team of nurses, can consistently maintain safe oxygen saturation levels.” 19 …”

Evaluación de la saturación arterial de oxígeno durante procedimientos de cirugía bucal en pacientes fumadores

“…Ningún paciente refirió antecedentes de estas patologías y el resto de las variables fueron controladas durante la realización del procedimiento. Aunque las saturaciones de un 2-3 % menos de la medición basal son difíciles de interpretar 2 , se ha reportado que la probabilidad de experimentar episodios de baja saturación se incrementa con la edad y es también mayor en pacientes de género masculino 3 ; ambas características fueron observadas en este grupo de pacientes con EPOC.…”

“…La utilización del oxímetro de pulso en procedimientos odontológicos permite medir el %SpO 2 . Algunas investigaciones previas han reportado datos sobre la incidencia, frecuencia, gravedad y duración de la desaturación de oxígeno arterial en pacientes sometidos a procedimientos de cirugía bucal ambulatoria [1][2][3] y otros estudios han comparado el comportamiento del %SpO 2 en diferentes intervenciones quirúrgicas, con anestesia local o sedación [4][5][6][7][8] , demostrando la importancia de la monitorización de este parámetro en la detección temprana de episodios de hipoxemia en pacientes con patologías sistémicas 9 . La enfermedad pulmonar obstructiva crónica (EPOC) es una entidad de alta prevalencia y comúnmente subdiagnosticada en pacientes fumadores asintomáticos, quienes pueden presentar alteraciones en el funcionalismo pulmonar [10][11][12][13] e hipoxemia durante la realización de procedimientos de cirugía bucal 14 .…”

The feasibility of office‐based propofol sedation for dental care in patients with intellectual disability by sedation practitioners

“…Viljoen et al. in their study on sedation in dentistry categorized saturation reading records as follows: light hypoxemia: SpO 2 ≤94%, moderate hypoxemia: SpO 2 93% to 90% and severe hypoxemia: SpO 2 <90%. In our study, the mean decrease of oxygen desaturation (≤92%) was 91.3% (SD: 0.985), while the lowest recorded reading ever was 89%.…”