ABSTRACT
Background:
Dental procedures often require local anesthesia, but managing fearful patients, especially children, can be challenging, potentially leading to dental phobia development. Sedation methods such as conscious sedation, deep sedation, or general anesthesia can aid in managing these patients.
Material and Method:
This study focuses on evaluating various sedation techniques used in an Oral and Maxillofacial Surgery Clinic for adults with special needs requiring dental treatments under sedation or general anesthesia. A retrospective analysis was conducted on 250 adult patients with special needs who underwent dental procedures between January 2019 and December 2023. Data on demographic characteristics, types of procedures, sedation techniques used, dosages, and complications were collected from medical records. Sedation techniques included midazolam-sufentanil, ketamine-midazolam, oral midazolam, chloral hydrate, ketamine, and propofol.
Results:
The midazolam-sufentanil combination was the most commonly used sedation technique (27.2%), followed by ketamine-midazolam (21.6%). Complications such as respiratory issues (2.9%), cardiovascular events (1.5%), nausea/vomiting (4.4%), and prolonged recovery time (2.9%) were observed.
Conclusion:
Overall, the incidence of complications was relatively low, indicating the safety and efficacy of the sedation techniques. Sedation techniques, particularly the midazolam-sufentanil and ketamine-midazolam combinations, were found to be effective and safe for managing dental procedures in adults with special needs. Personalized sedation approaches based on individual patient factors are essential for optimizing outcomes. Further research is needed to explore long-term effects and patient satisfaction.
KEYWORDS: Complications, dental sedation, ketamine-midazolam, midazolam-sufentanil, special needs
INTRODUCTION
Dental procedures are typically performed under local anesthesia. However, managing fearful patients presents a significant challenge because of their lack of cooperation. Alleviating anxiety and preventing psychological trauma is crucial to avoid the development of dental phobia, which can deter individuals from seeking necessary dental care.[1] Conscious sedation, deep sedation, or general anesthesia are often considered to facilitate dental treatments in such cases.[2]
Various anesthetic techniques have been used to achieve effective sedation in dental procedures. These include combinations such as midazolam-sufentanil and ketamine-midazolam, as well as oral midazolam, chloral hydrate, ketamine, and propofol.[3] Each technique offers distinct advantages and potential complications, influencing its suitability for different patient demographics and clinical scenarios.
This retrospective study aims to discuss the various sedation techniques used in our clinic and evaluate the complications observed after these procedures. By analyzing the outcomes associated with different sedation methods, we seek to provide insights that can enhance patient care and safety in dental practice.
METHODOLOGY
This retrospective study was conducted at the Oral and Maxillofacial Surgery Clinic to discuss various sedation techniques used and evaluate the complications observed after these procedures. The study focused on adult patients with special needs referred to our clinic from surrounding districts for dental treatments requiring sedation or general anesthesia. The inclusion criteria were adults aged 18 years and above with special needs who required sedation or general anesthesia for dental procedures and underwent these procedures between January 2019 and December 2023. Patients treated solely under local anesthesia without sedation and those with incomplete medical records or lacking follow-up data were excluded. A total of 250 patients met the inclusion criteria and were included in the study.
Data were collected retrospectively from the patients’ medical records. The extracted information included demographic data, type of dental procedure performed, sedation technique used, dosage and administration method of the sedative agents, and any intraoperative and postoperative complications. The study received approval from the Institutional Review Board of the hospital.
RESULTS
A total of 250 adult patients with special needs undergoing dental procedures requiring sedation or general anesthesia were included in the study. The mean age of the patients was 12.6 years (±5.4), with a range of 3 to 17 years. The majority of patients were male (56.8%), and the most common underlying medical condition was cardiovascular disease (20.8%). The most frequent type of dental procedure performed was tooth extraction (59.2%), followed by dental restorations (24.8%) and periodontal treatments (11.2%).
Various sedation techniques were used, with the most common being the midazolam-sufentanil combination (27.2%), followed by ketamine-midazolam (21.6%), oral midazolam (11.6%), chloral hydrate (16.4%), ketamine (13.6%), and propofol (9.6%). The average dosages for each sedative agent were within standard ranges as per clinical guidelines [Table 1].
Table 1.
Demographic and clinical characteristics of patients
| Characteristic | Number of patients (n=250) | Percentage (%) | Average dosage (±SD) |
|---|---|---|---|
| Age (years) | |||
| Mean (±SD) | 12.6 (± 5.4) | - | |
| Range | 3--17 | - | |
| Gender | |||
| Male | 142 | 56.80% | |
| Female | 108 | 43.20% | |
| Underlying medical conditions | |||
| Cardiovascular disease | 52 | 20.80% | |
| Respiratory disease | 28 | 11.20% | |
| Neurological disorders | 43 | 17.20% | |
| Others | 25 | 10.00% | |
| None | 102 | 40.80% | |
| Type of dental procedure | |||
| Tooth extraction | 148 | 59.20% | |
| Dental restorations | 62 | 24.80% | |
| Periodontal treatments | 28 | 11.20% | |
| Other | 12 | 4.80% | |
| Sedation technique | |||
| Midazolamsufentanil | 68 | 27.20% | Midazolam 0.05 mg/kg±0.01 |
| Sufentanil 0.2 μg/kg±0.05 | |||
| Ketamine-midazolam | 54 | 21.60% | Ketamine 1 mg/kg±0.2 |
| Midazolam 0.05 mg/kg±0.01 | |||
| Oral midazolam | 29 | 11.60% | 0.5 mg/kg±0.1 |
| Chloral hydrate | 41 | 16.40% | 50 mg/kg±5 |
| Ketamine | 34 | 13.60% | 1 mg/kg±0.2 |
| Propofol | 24 | 9.60% | 2 mg/kg±0.3 |
Several complications were observed after the use of different sedation techniques. Respiratory issues were reported in 2.9% of patients sedated with midazolam-sufentanil, 1.9% with ketamine-midazolam, 2.4% with chloral hydrate, 2.9% with ketamine, and 4.2% with propofol. Cardiovascular events occurred in 1.5% of patients sedated with midazolam-sufentanil, 1.9% with ketamine-midazolam, and 4.2% with propofol. Nausea and vomiting were observed in 4.4% of patients sedated with midazolam-sufentanil, 3.7% with ketamine-midazolam, 3.4% with oral midazolam, 2.4% with chloral hydrate, 5.9% with ketamine, and 4.2% with propofol. Prolonged recovery time was noted in 2.9% of patients sedated with midazolam-sufentanil, 1.9% with ketamine-midazolam, 2.4% with chloral hydrate, 2.9% with ketamine, and 4.2% with propofol.
Other complications were reported in 1.5% of patients sedated with midazolam-sufentanil, 1.9% with ketamine-midazolam, 2.4% with chloral hydrate, and 4.2% with propofol.
DISCUSSION
The findings of this study provide valuable insights into the use of sedation techniques in adults with special needs undergoing dental procedures. The majority of patients in our study required sedation or general anesthesia because of the complexity of their conditions, highlighting the importance of specialized care in managing this patient population. The most commonly used sedation techniques were the midazolam-sufentanil combination and ketamine-midazolam, which aligns with previous studies demonstrating their efficacy and safety in dental settings.[3]
Complications observed in our study, such as respiratory issues, cardiovascular events, and nausea/vomiting, were consistent with known risks associated with sedation techniques.[4] However, the overall incidence of complications was relatively low, suggesting that these techniques can be safely administered in a controlled clinical environment.
It is important to note that individual patient factors, such as age, underlying medical conditions, and the type of dental procedure, can influence the choice of sedation technique and the risk of complications. Therefore, a personalized approach to sedation management is crucial in optimizing patient outcomes.[5]
CONCLUSION
In conclusion, our study demonstrates that sedation techniques, particularly the midazolam-sufentanil and ketamine-midazolam combinations, are effective and safe for managing dental procedures in children with special needs. Although complications were observed, they were generally low in incidence, emphasizing the importance of proper patient selection and monitoring. Personalized sedation approaches based on individual patient factors are essential for optimizing outcomes.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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