Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Current trends in intravenous sedative drugs for dental procedures

  • Yoon, Ji-Young (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute) ;
  • Kim, Eun-Jung (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute)
  • Received : 2016.05.20
  • Accepted : 2016.06.10
  • Published : 2016.06.30
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Abstract

Anxiety and phobia in dental procedures are common deterrents for patients visiting the dental care unit. For these individuals, procedural sedation may aid in completion of dental treatments. In most cases, the patients are conscious during sedation, thereby allowing spontaneous ventilation. Intravenous sedation (IVS) is widely used during dental treatment to relieve patient anxiety. IVS is the most effective route of administration to achieve this goal, but it requires advanced training, more than that provided during undergraduate education. During IVS, rapid onset, repetitive drug administration, easy titration, and rapid recovery from sedation can be achieved. However, conscious sedation during IVS can result in deep sedation that can cause respiratory and cardiovascular depression. Therefore, the characteristics of intravenous sedatives should be known. The purpose of this review is to discuss the characteristics and usage of intravenous sedatives currently used for dental procedures.

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References

  1. Coolidge T, Irwin SP, Leyster KA, Milgrom P. Determinants of receiving intravenous sedation in a sample of dentally-fearful patients in the USA. SAAD Dig 2012; 28: 52-60.
  2. Sago T, Harano N, Chogyoji Y, Nunomaki M, Shiiba S, Watanabe S. A nasal high-flow system prevents hypoxia in dental patients under intravenous sedation. J Oral Maxillofac Surg 2015; 73: 1058-64. https://doi.org/10.1016/j.joms.2014.12.020
  3. Standing Dental Advisory Committee. Conscious sedation in the provision of dental care: New guidelines. SAAD Dig 2004; 21: 20-2.
  4. Ikeda H, Ayuse T, Oi K. The effects of head and body positioning on upper airway collapsibility in normal subjects who received midazolam sedation. J Clin Anesth 2006; 18: 185-93. https://doi.org/10.1016/j.jclinane.2005.08.010
  5. Urman RD, Punwani N, Shapiro FE. Patient safety and office-based anesthesia. Curr Opin Anaesthesiol 2012; 25: 648-53.
  6. Winsky-Sommerer R. Role of GABAA receptors in the physiology and pharmacology of sleep. Eur J Neurosci 2009; 29: 1779-94. https://doi.org/10.1111/j.1460-9568.2009.06716.x
  7. Zacharias M, Hunter KM, Luyk NH. Patient-controlled sedation using midazolam. Br J Oral Maxillofac Surg 1994; 32: 168-73. https://doi.org/10.1016/0266-4356(94)90103-1
  8. Coulthard P, Sano K, Thomson PJ, Macfarlane TV. The effects of midazolam and flumazenil on psychomotor function and alertness in human volunteers. Br Dent J 2000; 188: 325-8. https://doi.org/10.1038/sj.bdj.4800470
  9. Allonen H, Ziegler G, Klotz U. Midazolam kinetics. Clin Pharmacol Ther 1981; 30: 653-61. https://doi.org/10.1038/clpt.1981.217
  10. Greenblatt DJ, Divoll M, Abernethy DR, Locniskar A, Shader RI. Pharmacokinetics of benzodiazepine hypnotics. Pharmacology 1983; 27 Suppl 2: 70-5. https://doi.org/10.1159/000137913
  11. Golparvar M, Saghaei M, Sajedi P, Razavi SS. Paradoxical reaction following intravenous midazolam premedication in pediatric patients - a randomized placebo controlled trial of ketamine for rapid tranquilization. Paediatr Anaesth 2004; 14: 924-30. https://doi.org/10.1111/j.1460-9592.2004.01349.x
  12. McKenzie WS, Rosenberg M. Paradoxical reaction following administration of a benzodiazepine. J Oral Maxillofac Surg 2010; 68: 3034-6. https://doi.org/10.1016/j.joms.2010.06.176
  13. Martin G, Glass PS, Breslin DS, MacLeod DB, Sanderson IC, Lubarsky DA, et al. A study of anesthetic drug utilization in different age groups. J Clin Anesth 2003; 15: 194-200. https://doi.org/10.1016/S0952-8180(03)00030-8
  14. Krasowski MD, Nishikawa K, Nikolaeva N, Lin A, Harrison NL. Methionine 286 in transmembrane domain 3 of the GABAA receptor beta subunit controls a binding cavity for propofol and other alkylphenol general anesthetics. Neuropharmacology 2001; 41: 952-64. https://doi.org/10.1016/S0028-3908(01)00141-1
  15. Swanson ER, Seaberg DC, Mathias S. The use of propofol for sedation in the emergency department. Acad Emerg Med 1996; 3: 234-8. https://doi.org/10.1111/j.1553-2712.1996.tb03426.x
  16. Hughes MA, Glass PS, Jacobs JR. Context-sensitive halftime in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology 1992; 76: 334-41. https://doi.org/10.1097/00000542-199203000-00003
  17. Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, et al. Prevention of pain on injection of propofol: Systematic review and meta-analysis. BMJ 2011; 342: d1110. https://doi.org/10.1136/bmj.d1110
  18. McNeir DA, Mainous EG, Trieger N. Propofol as an intravenous agent in general anesthesia and conscious sedation. Anesth Prog 1988; 35: 147-51.
  19. Miner JR, Burton JH. Clinical practice advisory: Emergency department procedural sedation with propofol. Ann Emerg Med 2007; 50: 182,7, 187.e1. https://doi.org/10.1016/j.annemergmed.2006.12.017
  20. Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30: 119-41. https://doi.org/10.1097/00003246-200201000-00020
  21. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med 2011; 57: 449-61. https://doi.org/10.1016/j.annemergmed.2010.11.030
  22. Wood MN, Manley MC, Bezzina N, Hassan R. An audit of the use of intravenous ketamine for paediatric dental conscious sedation. Br Dent J 2015; 218: 573-7. https://doi.org/10.1038/sj.bdj.2015.390
  23. Krauss B, Green SM. Sedation and analgesia for procedures in children. N Engl J Med 2000; 342: 938-45. https://doi.org/10.1056/NEJM200003303421306
  24. Haas DA, Harper DG. Ketamine: A review of its pharmacologic properties and use in ambulatory anesthesia. Anesth Prog 1992; 39: 61-8.
  25. Green SM, Johnson NE. Ketamine sedation for pediatric procedures: Part 2, review and implications. Ann Emerg Med 1990; 19: 1033-46. https://doi.org/10.1016/S0196-0644(05)82569-7
  26. Wood M. The use of intravenous midazolam and ketamine in paediatric dental sedation. SAAD Dig 2013; 29: 18-30.
  27. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs 2000; 59: 263,8; discussion 269-70. https://doi.org/10.2165/00003495-200059020-00012
  28. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999; 54: 1136-42. https://doi.org/10.1046/j.1365-2044.1999.01114.x
  29. Dyck JB, Maze M, Haack C, Azarnoff DL, Vuorilehto L, Shafer SL. Computer-controlled infusion of intravenous dexmedetomidine hydrochloride in adult human volunteers. Anesthesiology 1993; 78: 821-8. https://doi.org/10.1097/00000542-199305000-00003
  30. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs 2000; 59: 263,8; discussion 269-70. https://doi.org/10.2165/00003495-200059020-00012
  31. Virtanen R, Savola JM, Saano V, Nyman L. Characterization of the selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist. Eur J Pharmacol 1988; 150: 9-14. https://doi.org/10.1016/0014-2999(88)90744-3

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