Risk Factors With Intravenous Sedation for Patients With Disabilities

Abstract

The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO 2 ) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO 2 ,90% and a recovery period of .60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO 2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003-7.978; 95% confidence interval; P , .001). Decision tree analysis showed an increased risk of decreased SpO 2 in males with Down syndrome or after administration of .0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered .0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO 2 . In addition, delayed recovery is expected after midazolam administration.

Paediatric procedural sedation at a tertiary care university teaching hospital in India

“…These findings are similar to what has been published previously 5,11,15 . Additionally patients with a diagnosis of cerebral palsy were at a higher risk of AE and this is consistent with findings from other studies especially with use of midazolam which has been to shown to give rise to agitation and delayed recovery 19 . This higher incidence of AE in patients with cerebral palsy could be attributed to multiple factors such as muscle tone, pharyngeal collapse, increased secretions and drug interactions with various medications used daily such as baclofen 20 .…”

Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types

“…Moreover, deep sedation is performed to reduce patient movement owing to a lack of cooperation in which dental treatment cannot be carried out with minimal sedation. Deep sedation can be easily and safely achieved intravenously by the ease of handling the doses as we can titrate to achieve the desired effect, among the most commonly used sedative drugs like benzodiazepines between this one, we have midazolam which is considered the drug most commonly used to induce sedation in dental procedures [13]. Despite the sedative, hypnotic, anxiolytic, amnesic, and muscle relaxant effects of midazolam, it has been reported to produce delayed recovery in patients with disabilities after treatment completion.…”

Oral Rehabilitation with Implant‐Retained Overdenture in a Patient with Down Syndrome

“…They determined that the most problematic group with the highest risk of poor sedation control during dental treatment was patients with Down syndrome, compared to patients with disabilities such as cerebral palsy and mental retardation. Low SpO 2 during sedation is associated with sleep apnea and upper‐airway obstruction due to the presence of a large tongue . Careful intraoral examination and close monitoring of patients with Down syndrome is therefore very important during IV sedation.…”

“…Low SpO 2 during sedation is associated with sleep apnea and upper-airway obstruction due to the presence of a large tongue. 27 Careful intraoral examination and close monitoring of patients with Down syndrome is therefore very important during IV sedation.…”