J Dent Anesth Pain Med.  2017 Sep;17(3):199-204. 10.17245/jdapm.2017.17.3.199.

Complications associated with intravenous midazolam and fentanyl sedation in patients undergoing minor oral surgery

• Saiso K
• Adnonla P
• Munsil J
• Apipan B
• Rummasak D
• Wongsirichat N

• KMID: 2390804
• DOI: http://doi.org/10.17245/jdapm.2017.17.3.199

Abstract

BACKGROUND
Anxiety control remains an important concern in dental practice. We evaluated the incidence, nature, and sequelae of complications during and after minor oral surgeries performed under intravenous midazolam and fentanyl sedation using the titration technique.
METHODS
The medical records of patients who had undergone minor oral surgeries under moderate intravenous midazolam and fentanyl sedation at our institution between January 1, 2015 and December 31, 2015 were retrospectively evaluated. Age, sex, body mass index, medical history, American Society of Anesthesiologists (ASA) classification, indications for sedation, amount of sedative used, surgical duration, and recovery time were evaluated for all patients.
RESULTS
In total, 107 patients aged 9-84 years were included. ASA class I and class II were observed for 56.1% and 43.9% patients, respectively. Complications associated with sedation occurred in 11 (10.2%) patients. There were no serious adverse events. Oxygen saturation reached 95% during the procedure in six patients; this was successfully managed by stimulating the patients to take a deep breath. Two patients exhibited deep sedation and one exhibited paradoxical excitement. After the procedure, one patient experienced nausea without vomiting and one exhibited a prolonged recovery time. The surgical procedures were completed in all patients. Obesity was found to be significantly associated with sedation-related complications.
CONCLUSIONS
Our results suggest that complications associated with intravenous midazolam and fentanyl sedation using the titration technique for minor oral surgeries are mostly minor and can be successfully managed with no prolonged sequelae.

Keyword

Body Mass Index; Complications; Fentanyl; Midazolam; Minor Surgery; Obesity

MeSH Terms

Anxiety
Body Mass Index
Classification
Deep Sedation
Fentanyl*
Humans
Incidence
Medical Records
Midazolam*
Minor Surgical Procedures
Nausea
Obesity
Oxygen
Retrospective Studies
Surgery, Oral*
Vomiting
Fentanyl
Midazolam
Oxygen

Reference

1. Runes J, Ström C. Midazolam intravenous conscious sedation in oral surgery. A retrospective study of 372 cases. Swed Dent J. 1996; 20:29–33. PMID: 8738906.

2. Averley PA, Lane I, Sykes J, Girdler NM, Steen N, Bond S. An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment--an alternative to general anaesthesia. Br Dent J. 2004; 197:553–558. PMID: 15543117.

3. Miyawaki T, Kohjitani A, Maeda S, Egusa M, Mori T, Higuchi H, et al. Intravenous sedation for dental patients with intellectual disability. J Intellect Disabil Res. 2004; 48:764–768. PMID: 15494066.

4. Garip H, Gürkan Y, Toker K, Göker K. A comparison of midazolam with remifentanil for patient-controlled sedation during operations on third molars. Br J Oral Maxillofac Surg. 2007; 45:212–216. PMID: 16930785.

5. Garip H, Satımıs T, Dergin G, Ugurlu F, Göke K. Effects of midazolam/low-dose ketamine conscious intravenous sedation on pain, swelling, and trismus after surgical extraction of third molars. J Oral Maxillofac Surg. 2011; 69:1023–1030. PMID: 21216077.

6. Foley J. The way forward for dental sedation and primary care? Br Dent J. 2002; 193:161–164. PMID: 12213010.

7. Wilson KE, Thorpe RJ, McCabe JF, Girdler NM. Complications associated with intravenous midazolam sedation in anxious dental patients. Prim Dent Care. 2011; 18:161–166. PMID: 21968043.

8. Rodgers SF, Rodgers MS. Safety of intravenous sedation administered by the operating oral surgeon: the second 7 years of office practice. J Oral Maxillofac Surg. 2011; 69:2525–2529. PMID: 21724314.

9. Inverso G, Dodson TB, Gonzalez ML, Chuang SK. Complications of moderate sedation versus deep sedation/general anesthesia for adolescent patients undergoing third-molar extraction. J Oral Maxillofac Surg. 2016; 74:474–479. PMID: 26546845.

10. Senel AC, Altintas NY, Senel FC, Pampu A, Tosun E, Ungor C, et al. Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: failure and complications. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114(5):592–596. PMID: 22901639.

11. Kouchaji C. Complications of IV sedation for dental treatment in individuals with intellectual disability. Eg J Anaesth. 2015; 31:143–148.

12. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974; 2:656–659. PMID: 4835444.

13. Wong M, Lytle WR. A comparison of anxiety levels associated with root canal therapy and oral surgery treatment. J Endod. 1991; 17:461–465. PMID: 1811042.

14. Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006; 118:2587–2602. PMID: 17142550.

15. American Society of Anesthesiologists Task force on Sedation and Analgesia by Non- Anesthesiologist. Practice Guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002; 96:1004–1017. PMID: 11964611.

16. Godwin SA, Caro DA, Wolf SJ, Jagoda AS, Charles R, Marett BE, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005; 45:177–196. PMID: 15671976.

17. American Dental Association. Guidelines for teaching pain control and sedation to dentists and dental students: as adopted by the October 2007 ADA House of Delegates. Accessed May 24, 2017. Available from https://www.ada.org/~/media/ADA/Member%20Center/FIles/anxiety_guidelines.ashx.

18. American Dental Association. Guidelines for the use of sedation and general anesthesia by dentists: as adopted by the October 2016 ADA House of Delegates. Accessed May 24, 2017. Available from http://www.ada.org/~/media/ADA/Advocacy/Files/anesthesia_use_guidelines.pdf?la=en.

19. Mason KP, Green SM, Piacevoli Q. Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: a consensus document from the World SIVA international sedation task force. Br J Anaesth. 2012; 108:13–20. PMID: 22157446.