Safety of Conscious Sedation/Analgesia for Dentistry; A Comparison of Midazolam/Fentanyl Vs Promazine/Meperidine

Author(s): Claudio Melloni

The anesthesia charts of adult patients undergoing dental surgery lasting >1 h (sinus lift, multiple implants, multiple wisdom teeth extractions) were retrospectively analyzed comparing meperidine/promazine (MEPPROM, 93 cases, 2018-20) to midazolam/fentanyl (MIDFENT, 415 cases, 2011-2020). Patients signed an informed consent, completed a health questionnaire; afer diazepam premedication and full monitoring sedation started with midazolam 1-2 mg: the group MEPPROM received the mixture according to weight, the group MIDFENT received additional midazolam and fentanyl 25-50 microgr. Midazolam for sedation or fentanyl for analgesia was allowed in both groups on demand, aiming at Ramsay score 2-3. Dental anesthesia (articaine or mepivacaine + epinephrine) followed, repeated as needed. The study variables were collected every 5 minutes on specially designed sheets:oxygen desaturation (<90%), brady/tachycardia (<50, >120 bpm), hyper/hypotension (>180, <90 mmHg systolic or >30% difference versus basal), sleep (Ramsay score 4), hypercapnia (etCO2> 40 mmg), nausea, vasovagal reactions, arrhythmias. Age (59), weight (KG 70), height (cm 167). ASA class (1-3), sex were equally distributed between the 2 groups; surgery was longer in the MEPPROM group (148 min vs 118) (averages). Hypertension incidence was similar, but 40 MIDFENT patients received clonidine vs 1 in the MEPPROM. Frequence (%) of hypotension (20 vs 2), tachycardia (15 vs 1), bradycardia (11 vs 4) were always greater in the group MEPPROM. Incidence of desaturation, hypercapnia, excessive sedation were similar. Side effects did not differ:nausea (2 MEPPROM, 4 MIDFENT but with frequent use of haloperidol), vasovagal syndromes (2 MEPPROM, 5 MIDFENT). All patients were discharged within 1 hr after surgery. Under careful titration MEPPROM offer clinical conditions similar to the established MIDFENT routine; however haemodynamic disturbances are more frequent and call for expert vigilance and continuous monitoring of vital signs.

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