Are there risks with intravenous sedation for patients with disabilities?

This summary is based on the article published in Anesthesia Progress:  Risk Factors With Intravenous Sedation for Patients With Disabilities (Winter 2013)

Fumihiro Yoshikawa, DDS, PhD, Yoh Tamaki, DDS, PhD, Hisa Okumura, DDS, PhD, Zenzo Miwa, DDS, PhD, Masaaki Ishikawa, DDS, PhD, Kazuhiro Shimoyama, DDS, PhD, Zenkou Nakamura, DDS, DMSc, Hitomi Kunimori, DDS, Shigeharu Jinno, DDS, PhD, Hikaru Kohase, DDS, PhD, and Haruhisa Fukayama, DDS, PhD

Context

Dental practices are currently challenged by the rapidly growing number of patients with intellectual or physical disabilities. (1,2)

Excessive mental strain during dental treatment can cause systemic complications such as vasovagal reflex, neurogenic shock, pain shock, and hyperventilation. Patients with cardiovascular diseases, including cerebrovascular disorders, or decreased vital organ reserve capacity can encounter serious complications.

When using intravenous sedative drugs that have strong systemic actions on the central nervous, respiratory, and circulatory systems, systemic management to ensure patient safety is a prerequisite. (3, 4) 

Purpose of the Study

To identify the risk factors associated with low peripheral oxygen saturation (SpO2) and delayed recovery of dental patients with disabilities after intravenous sedation.

Key Findings

• A significant odds ratio related to decreased SpO2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation.
• Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO2. In addition, delayed recovery is expected after midazolam administration.

References

1. Glassman P. A review of guidelines for sedation, anesthesia, and alternative interventions for people with special needs. Spec Care Dentist. 2009; 29:9–16.
2. Wang YC, Lin IH, Huang CH, Fan SZ. Dental anesthesia for patients with special needs. Acta Anaesthesiol Taiwan. 2012; 50:122–125.
3. Dionne RA, Yagiela JA, Moore PA, et al. Comparing efficacy and safety of four intravenous sedation regimens in dental outpatients. J Am Dent Assoc. 2001;132:740–751.
4. American Society of Anesthesiologists Task Force on Sedation and Anesthesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002; 96:1004–1017.

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