임플란트 수술을 위한 미다졸람 정주와 아산화질소 흡입 병용 진정법의 효과와 안전성에 대한 전향적 무작위 대조군 연구

A Prospective, Randomized and Controlled Study for the Efficacy and Safety of Sedation Technique for Implant Surgery by Combining Nitrous Oxide and Intravenous Midazolam

  • 전승환 (한양대학교 의과대학 치과학교실 구강악안면외과) ;
  • 정신혜 (한양대학교 의과대학 치과학교실 치과보존과) ;
  • 김광수 (한양대학교 의과대학 치과학교실 예방치과) ;
  • 전상호 (고려대학교 안암병원 치과 구강악안면외과) ;
  • 황경균 (한양대학교 의과대학 치과학교실 구강악안면외과) ;
  • 박창주 (한양대학교 의과대학 치과학교실 구강악안면외과)
  • Jeon, Seung-Hwan (Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University) ;
  • Chung, Shin-Hye (Division of Conservative Dentistry, Department of Dentistry, College of Medicine, Hanyang University) ;
  • Kim, Kwang-Soo (Division of Preventive Dentistry, Department of Dentistry, College of Medicine, Hanyang University) ;
  • Jun, Sang-Ho (Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Korea University) ;
  • Hwang, Kyung-Gyun (Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University) ;
  • Park, Chang-Joo (Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University)
  • 투고 : 2012.06.15
  • 심사 : 2012.07.02
  • 발행 : 2012.06.30

초록

Background: The purpose of this study is to investigate the efficacy and safety of the sedation technique for implant surgery by combining the use of inhalation of nitrous oxide/oxygen with intravenous midazolam. Methods: Patients requiring surgery for the placement of dental implants were randomly allocated to two groups receiving intravenous midazolam or a combined technique using nitrous oxide/oxide and intravenous midazolam. Safety parameters, cooperation scores, anxiety scales, total amount of midazolam administered and recovery time were recorded and compared. Results: There were a statistically significant reduction in the amount of midazolam required to achieve optimal sedation (P<0.01), an overall significant reduction in recovery time (P<0.01), a significant reduction in anxiety scales (P<0.05), and a significant improvement in cooperation (P<0.05) and peripheral oxygen saturation (P<0.05) when a combined technique of inhalational $N_2O/O_2$ and midazolam was used. Conclusions: For implant surgery, this combining sedation technique could be safe and reliable, demonstrating reduction of total dose of midazolam and level of patient's anxiety and improvement in patient's recovery and cooperation.

키워드

참고문헌

  1. Lindsay S, Humphris G, Barnby G: Expectation and preferences for routine dentistry in anxious dental patients. Br Dent J 1987; 163: 120-4. https://doi.org/10.1038/sj.bdj.4806218
  2. Mililgrom P, Weistein B, Kleinknecht R: Treating fearful dental patients. 2nd ed. New York, Reston Publishing. 1995, pp 135-51.
  3. Malamed SF: Sedation: A guide topatient management. 4th ed. St Louis, Mosby. 2003, pp 167-224.
  4. Haas DA: Oral and inhalation conscious sedation. Dent Clin North Am 1999; 43: 341-59.
  5. Coulthard P: Conscious sedation guidance. Evid Based Dent 2006; 7: 90-1. https://doi.org/10.1038/sj.ebd.6400441
  6. Craig DC, Wildsmith JA: Conscious sedation for dentistry: an update. Br Dent J 2007; 203: 629-31. https://doi.org/10.1038/bdj.2007.1105
  7. Hallonsten AL: Sedation by the use of inhalation agents in dental care. Acta Anaesthesiol Scand Suppl 1988; 88: 31-5.
  8. Jackson DL, Johnson BS: Inhalational and enteral conscious sedation for the adult dental patient. Dent Clin North Am 2002; 46: 781-802. https://doi.org/10.1016/S0011-8532(02)00029-0
  9. Parbrook GD: The levels of nitrousoxide analgesia. Br J Anaesth 1967; 39: 974-82. https://doi.org/10.1093/bja/39.12.974
  10. Starch DJ: Nitrous oxide sedation, understanding the benefits and risks. Am J Dent 1995; 8: 47-50.
  11. Crecelius C, Rouhfar L, Beirne OR: Venous cannulation and topical ethyl chloride in patients receiving nitrous oxide. Anesth Prog 1999; 46: 100-3.
  12. Yoshida M, Araki H, Yamaguchi T, Uchida A, Nakajima I: Mandibular-position sensation during sedation by administration of nitrous-oxide (N2O) gas. J Oral Sci 1999; 41: 123-6. https://doi.org/10.2334/josnusd.41.123
  13. Yoshida M, Nakajima I, Uchida A, Yamaguchi T, Akasaka M: Effect of nitrous oxide on dental patients with cerebral palsy - using an electromyogram (EMG) from orofacial muscles as an index. J Oral Rehabil 2003; 30: 324-33. https://doi.org/10.1046/j.1365-2842.2003.00979.x
  14. Allonen H, Ziegler G, Klotz U: Midazolamkinetics. Clin Pharmacol Ther 1981; 30: 653-61. https://doi.org/10.1038/clpt.1981.217
  15. Reeves IG, Fragen RJ, Vinik HR: Midazolam: pharmacology and uses. Anaesthesiol J 1985; 62: 310-24. https://doi.org/10.1097/00000542-198503000-00017
  16. Venchard GR, Thomson PJ, Boys R: Improved sedation for oral surgery by combining nitrous oxide and intravenous Midazolam: a randomized, controlled trial. Int J Oral Maxillofac Surg 2006; 35: 522-7. https://doi.org/10.1016/j.ijom.2005.11.003
  17. Corah NL: Development of a dental anxiety scale. J Dent Res 1969; 48: 596.
  18. Gonzalez-Lemonnier S, Bovaira-Forner M, Peñarrocha- Diago D, Peña-rrocha-Diago MA: Hemodynamic and ventilatory changes during implant surgery with intravenous conscious sedation. Med Oral Patol Oral Cir Bucal 2011; 16: 541-5.
  19. Goodson JM, Moore PA: Life-threatening reactions after pedodontic sedation: An assessment of narcotic, local anesthetic, and antiemetic drug interaction. J Am Dent Assoc 1983; 107: 239-45. https://doi.org/10.14219/jada.archive.1983.0225
  20. Houpt M, Manetas C, Joshi A, Desjardins P: Effects of chloral hydrateon nitrous oxide sedation of children. Pediatr Dent 1989; 11: 26-9.
  21. Hartgraves PM, Primosch RE: An evaluation of oral and nasalmidazolam for pediatric dental sedation. J Dent Child 1994; 61: 175-81.
  22. Wilton NCT, Leigh J, Rosen DR, Pandit UA: Preanesthetic sedationof preschool children using intranasal midazolam. Anesthesiology 1988; 69: 972-5. https://doi.org/10.1097/00000542-198812000-00032
  23. McMillan CO, Spahr-Schopfer IA, Sikich N, Hartley E, Lerman J: Premedicationof children with oral midazolam. Can J Anaesth 1992; 39: 545-50. https://doi.org/10.1007/BF03008315
  24. Forster A, Gardaz J, Suter PM, Gemperle M: Respiratory depression by midazolam and diazepam. Anesthesiology 1980; 53: 494-7. https://doi.org/10.1097/00000542-198012000-00010
  25. Drummond GB: Comparison of sedation with midazolam and ketamine: Effects on airway muscle activity. Br J Anaesth 1996;76: 663-7. https://doi.org/10.1093/bja/76.5.663
  26. Montravers P, Dureuil B, Desmonts JM: Effects of i.v. midazolam on upper airway resistance. Br J Anaesth 1992; 68: 27-31. https://doi.org/10.1093/bja/68.1.27
  27. LuhmannJD, Kennedy RM, PorterFL: A randomised clinical trial of continuous flow nitrous oxide and midazolam for sedation of young children during laceration repair. Ann Emerg Med 2001; 37: 20-7. https://doi.org/10.1067/mem.2001.112003
  28. Litman RS, Berkowitz RJ, Ward DS: Levels of consciousness and ventilator parameters in young children during sedation with oral midazolam and nitrous oxide. Arch Pediatr Adolesc Med 1996; 150: 671-5. https://doi.org/10.1001/archpedi.1996.02170320017002