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Journal of Peking University(Health Sciences) ›› 2020, Vol. 52 ›› Issue (1): 181-186. doi: 10.19723/j.issn.1671-167X.2020.01.029

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Application of intravenous sedation in 2 582 cases of oral and maxillofacial surgery

Fei WANG1,Yang-yang ZHAO2,Ming GUAN3,Jing WANG1,Xiang-liang XU1,Yu LIU1,Xin-li ZHAI1,△()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Stomatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
    3. First Clinical Division, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2019-10-10 Online:2020-02-18 Published:2020-02-20
  • Contact: Xin-li ZHAI E-mail:zzxxll50@163.com

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Abstract:

Objective: To analyze the clinical data of patients undergoing intravenous sedation in oral and maxillofacial surgery, to understand the epidemiological characteristics, to evaluate the efficacy and safety of intravenous sedation for oral surgery, and to summarize our experience. Methods: We retrospectively reviewed the clinical data of patients undergoing intravenous sedation between January 2010 and December 2018 in the Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology. The gender, age, source, disease types, the values of perioperative vital signs, the use of sedatives and analgesics, duration of surgery and sedation, effect of sedation during the operation and the postoperative anterograde amnesia were analyzed. Results: A total of 2 582 patients experienced oral surgery by intravenous sedation. The peak age was 3.5 to 10 years and between 21 to 40 years. Supernumerary teeth (38%, 981/2 582) and impacted third molars (30%, 775/2 582) were the major disease types, and other types of disease accounted for 32 percent (826/2 582). The values of heart rate(HR),mean arterial pressure(MAP),respiration rate(RR) and bispectral index(BIS) showed statistically significant differences at the time of before sedation, local anesthesia injection, surgical incision, 10 min after operation and the end of operation. In the study, 69%(1 781/2 582) cases received midazolam alone, 7%(181/2 582) cases received propofol alone, and 24%(620/2 582) cases received midazolam and propofol combined for intravenous sedation. Fentanyl (33%, 852/2 582)was the most common intravenous analgesic we used, followed by flurbiprofen axetil (23%, 594/2 582) and ketorolac tromethamine (6%, 157/2 582). Besides, 35% (907/2 582)patients didn't use any intravenous analgesic during the surgery. The average operation time was (31.2±20.8) min, and the average sedation time was (38.4±19.2) min. During the surgery procedure, most of the patients scored on a scale of 2 to 4 according to the Ramsay sedation score (RSS). The postoperative anterograde amnesia rates of local anesthesia injection, surgical incision and dental drill during surgery were 94% (2 431/2 582), 92% (2 375/2 582) and 75% (1 452/1 936). Conclusion: Intravenous sedation on the oral and maxillofacial surgery is effective and safe, can make the patients more comfortable, and should be further promoted and applied.

Key words: Intravenous sedation, Analgesia, Anesthesia, Oral and maxillofacial surgery

CLC Number: 

  • R782.05

Figure 1

Distribution of different ages"

Figure 2

Distribution of disease types"

Table 1

The values of BIS, HR, MAP, RR and SpO2 at different time during operation(x?±s)"

Items T0 T1 T2 T3 T4
BIS 96.76±0.95 75.57±3.53* 76.12±2.84* 75.02±3.17* 80.37±2.75*#&§
HR/(beat/min) 88.31±20.58 79.87±14.94* 82.44±13.80*# 81.16±14.98*# 82.98±17.89*#
MAP/mmHg 94.68±9.95 84.43±8.54* 83.66±11.14* 81.96±9.44* 82.72±8.93*
RR/(beat/min) 18.65±3.87 16.89±4.33* 17.37±2.02* 17.82±3.18* 17.02±2.27*
SpO2/% 99.12±0.84 99.03±0.67 98.87±1.06 99.11±0.66 99.02±1.14

Table 2

Patients evaluated by Ramsay sedation score at different surgeries"

Items RSS=1 RSS=2 RSS=3 RSS=4 RSS=5 RSS=6
Supernumerary tooth 21 215 591 143 11 0
Impected wisdom tooth 9 215 453 94 4 0
Odontogenic cyst 3 76 115 36 2 0
Others 18 236 269 62 9 0
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