Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures

Abstract

Background: Intravenous sedation is effective in patients undergoing dental procedures, but fatal hypoxemic events have been documented. It was hypothesized that abnormal breathing events occur frequently and are underdetected by pulse oximetry during sedation for dental procedures (primary hypothesis) and that insertion of a small-diameter nasopharyngeal tube reduces the frequency of the abnormal breathing events (secondary hypothesis). Methods: In this nonblinded randomized control study, frequency of abnormal breathing episodes per hour (abnormal breathing index) of the patients under sedation for dental procedures was determined and used as a primary outcome to test the hypotheses. Abnormal breathing indexes were measured by a portable sleep monitor. Of the 46 participants, 43 were randomly allocated to the control group (n = 23, no nasopharyngeal tube) and the nasopharyngeal tube group (n = 20). results: In the control group, nondesaturated abnormal breathing index was higher than the desaturated abnormal breathing index (35.2 [20.6, 48.0] vs. 7.2 [4.1, 18.5] h −1 , difference: 25.1 [95% CI, 13.8 to 36.4], P < 0.001). The obstructive abnormal breathing index was greater than central abnormal breathing index (P < 0.001), and half of abnormal breathing indexes were followed by irregular breathing. Despite the obstructive nature of abnormal breathing, the nasopharyngeal tube did not significantly reduce the abnormal breathing index (48.0 [33.8, 64.4] h −1 vs. 50.5 [36.4, 63.9] h −1 , difference: −2.0 [95% CI, −15.2 to 11.2], P = 0.846), not supporting the secondary hypothesis. conclusions: Patients under sedation for dental procedure frequently encounter obstructive apnea/hypopnea events. The majority of the obstructive apnea/hypopnea events were not detectable by pulse oximetry. The effectiveness of a small-diameter nasopharyngeal tube to mitigate the events is limited.

The face of Dental Sleep Medicine in the 21st century

“…Anaesthesiologist have an important role in screening of the patients, the early recognition of OSA, and caring for a patent upper airway during deeper sedation procedures. 72 Patients with OSA present with oxidative stress and systemic inflammation. 73,74 Periodontal disease shares some of these mechanisms, and recent studies have shown a significant association with OSA.…”

“…Dental anaesthesiology is linked to OSA, because OSA patients are often prone to increased risk of complications during deeper sedation. Anaesthesiologist have an important role in screening of the patients, the early recognition of OSA, and caring for a patent upper airway during deeper sedation procedures 72 …”

Occurrence of Cortical Arousal at Recovery from Respiratory Disturbances during Deep Propofol Sedation

“…Pharmacological sedation is becoming frequently used in various clinical situations such as invasive endoscopy, minor surgery, radiological examinations for children, and mechanical ventilation in ICU [10,25,26,27]. Apneas and hypopneas during sedation were spontaneously terminated either with or without cortical arousal in our patients.…”

“…In fact, deaths in patients undergoing GI endoscopy during and after propofol sedation have been reported [19]. Clearly, future studies need to explore clinical significance of the non-hypoxemic respiratory disturbances and roles of the respiratory monitoring such as capnography, nasal pressure, snoring sound measurement during sedation [25,29,30,31].…”

Control of Tongue Position in Patients with Obstructive Sleep Apnea: Concept and Protocol for a Randomized Controlled Crossover Trial

“…will be informed of the allocation of the participant immediately before the initiation of intravenous sedation to reduce potential bias. The anesthesiologist will provide conscious intravenous sedation by a bolus intravenous injection of midazolam (1 to 3 mg) and propofol (5 to 10 mg), followed by continuous infusions of propofol (1 to 3 mg kg −1 h −1 ) using the target-controlled infusion system [19,20]. After an acclimatization period for TPR (30 s), a baseline evaluation (i.e., no control of tongue position with TPR in place) will be performed (1 min) (Figure 4).…”