J Korean Assoc Oral Maxillofac Surg.  2017 Aug;43(4):229-238. 10.5125/jkaoms.2017.43.4.229.

Risk factor analysis of additional administration of sedative agent and patient dissatisfaction in intravenous conscious sedation using midazolam for third molar extraction

• Shin DW
• Cho JY
• Han YS
• Sim HY
• Kim HS
• Jung DU
• Lee H

• KMID: 2391353
• DOI: http://doi.org/10.5125/jkaoms.2017.43.4.229

Abstract

OBJECTIVES
The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction.
MATERIALS AND METHODS
Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer's assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05.
RESULTS
Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction.
CONCLUSION
The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.

Keyword

Midazolam; Conscious sedation; Drug dosage calculation; Patient satisfaction; Third molar

MeSH Terms

Amnesia
Blood Pressure
Body Mass Index
Case-Control Studies
Conscious Sedation*
Dental Anxiety
Drug Dosage Calculations
Heart Rate
Humans
Midazolam*
Molar, Third*
Oxygen
Patient Satisfaction
Retrospective Studies
Risk Factors*
Surgery, Oral
Midazolam
Oxygen

Figure

• 

  Fig. 1 Comparison of several variables in cases stratified by the necessity of addition administration of midazolam during surgical extraction of third molars. A. Comparison according to the age. B. Comparison according to body mass index (BMI). C. Comparison according to observer's assessment of alertness/sedation (OAA/S). (No: no addition group, Add: addition group)

• 

  Fig. 2 Comparison of BIS and vital signs in cases stratified by the necessity of addition administration of midazolam during surgical extraction of third molars. Values are presented as mean±standard deviation. A. Comparison according to the mean bispectral index score (BIS). B. Comparison according to the mean heart rate. C. Comparison according to the mean systolic NIBP. D. Comparison according to the mean diastolic noninvasive blood pressure (NIBP). (T0: the moment right before midazolam administration, T1: the moment 5 minutes after midazolam administration, T2: the time of injection of the local anesthetic agent, T3: the moment 20 minutes after local anesthesia, T4: the time of the first stitch, No: no addition group, Add: addition group)

• 

  Fig. 3 Receiver operating characteristics curve obtained by multivariable logistic regression. A. The cut-off-value for age was 22.5 years with an area-under-curve of 0.741 (P=0.001). It was determined according to the Youden index with sensitivity of 64.8% and specificity of 73.7%. B. The cut-off-value for bispectral index score on T0 was 95.5 with an area-under-curve of 0.673 (P=0.043). It was determined according to the Youden index with sensitivity of 76.9% and specificity of 59.2%. (T0: the moment right before midazolam administration)

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