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Comparison of patient-controlled and operator-controlled conscious sedation for restorative dentistry

Published online by Cambridge University Press:  23 December 2004

K. A. Bavisha ,
M. Elias ,
S. Paris ,
A. R. Leon  and
P. J. Flynn
K. A. Bavisha
Affiliation:
The Royal London Hospital, London
M. Elias
Affiliation:
Royal United Hospital Bath NHS Trust, Bath, UK
S. Paris
Affiliation:
St Lukes Hospital Gwardamanga, Malta
A. R. Leon
Affiliation:
Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK
P. J. Flynn
Affiliation:
Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK
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Extract

Summary

Background and objective: The use of midazolam for conscious sedation is an accepted method of anxiety control in restorative dentistry. A lack of predictability in its effects requires the dose of midazolam to be adjusted to individual patient's requirements. We determined whether patient-controlled sedation was a suitable alternative to operator-controlled sedation in restorative dentistry.

Methods: A randomized crossover clinical trial involving 35 consecutive patients undergoing similar dental procedures. Patients were randomly given midazolam, administered either by the patient or by the operator at the first visit and the alternative option on the second visit. All patients were ASA I–II and their ages ranged between 20 and 48 yr. Blood pressure, heart rate, oxygen saturation and patient satisfaction were recorded.

Results: The onset time and initial dose for sedation were similar with the two methods of administration and the sedation scores and vital signs were satisfactory. In the patient-controlled group the mean total dose of midazolam was 7.9 (±4.2 SD) mg cf. 4.2 (±1.8 SD) mg in the operator-controlled group (P < 0.05). The time to fitness for discharge (15.4 (± 11.9 SD) min) was greater in the patient-controlled group cf. the operator-controlled group (8.5 (±9.5 SD) min), P < 0.05.

Conclusion: This study shows that patient-controlled sedation is a suitable alternative to operator-controlled sedation in the management of anxious dental patients.

Keywords

ANAESTHESIA AND ANALGESIA, conscious sedationBENZODIAZEPINES midazolamDENTISTRY, OPERATIVEdental restoration, permanent
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 4 , April 2004 , pp. 284 - 288
Copyright
2004 European Society of Anaesthesiology

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References

General Dental Council. Maintaining Standards, Guidance to Dentists on Professional and Personal Conduct.London, UK: General Dental Council, Revised November 2001.
A Conscious Decision: Report of an Expert Group. London, UK: Department of Health, July 2000.
Dundee JW, Halliday NJ, Harper KW, Brogden RN. Midazolam: a review of its pharmacological properties and therapeutic use. Drugs 1984; 28: 519–543.Google Scholar
Hillestad L, Hansen T, Melsom H, Drivenes A. Diazepam metabolism in normal man. 1. Serum concentrations and clinical effects after intravenous, intramuscular, and oral administration. Clin Pharmacol Ther 1974; 16: 479–484.Google Scholar
Corman HH, Hornick EJ, Kritchman M, Terestman N. Emotional reactions of surgical patients to hospitalization, anesthesia and surgery. Am J Surg 1958; 96: 646–653.Google Scholar
Sechzer PH. Objective measurement of pain. Anesthesiology 1968; 29: 209–210.Google Scholar
Osborne GA, Rudkin GE, Curtis NJ, Vickers D, Craker AJ. Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with anaesthetist-administered midazolam and fentanyl. Anaesthesia 1991; 46: 553–556.Google Scholar
Zacharias M, Hunter KM, Luyk NH. Patient-controlled sedation using midazolam. Br J Oral Maxillofac Surg 1994; 32: 168–173.Google Scholar
Rodrigo MR, Tong CK. A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery. Anaesthesia 1994; 49: 241–244.Google Scholar
Rodrigo C, Chow KC. Patient-controlled sedation: a comparison of sedation prior to and until the end of minor oral surgery. Aust Dent J 1996; 41: 159–163.Google Scholar
Poswillo D. General Anaesthesia, Sedation and Resuscitation in Dentistry. Report of an Expert Working Party 1990.Prepared for the Standing Dental Advisory Committee. London, UK: Department of Health.
Dell R. A review of patient-controlled sedation. Eur J Anaesthesiol 1996; 13: 547–552.Google Scholar