Intravenous Sedation for Implant Surgery: Midazolam, Butorphanol, and Dexmedetomidine Versus Midazolam, Butorphanol, and Propofol
We compared the amnesic action, recovery process, and satisfaction of patients and surgeons after the use of 2 different sedation regimens for 40 patients undergoing scheduled implant surgery. Butorphanol, midazolam, dexmedetomidine (BMD) was administered to 20 patients who were maintained with continuous infusion of dexmedetomidine after the induction with butorphanol and midazolam, and butorphanol, midazolam, propofol (BMP) was administered to 20 patients who were maintained with continuous infusion of propofol after the induction with butorphanol and midazolam. To assess the amnesic action, the memory of local anesthesia, auditory memory, and visual memory were evaluated. The Trieger Dot Test (TDT) was applied during the recovery process. A questionnaire regarding the patient's feelings of the management of sedation was taken from each patient and was also filled out by the surgeon. The comparison between groups was analyzed by the Mann-Whitney U test. No significant differences in the amnesic action and the TDT were noted. Both methods also satisfied the patients and surgeons, as determined by the questionnaire results. In conclusion, both sedation regimens are appropriate for implant surgery.
The time course of the investigation. The subjects' blood pressure, heart rate, electrocardiogram, and SpO2 (percentage percutaneous oxygen saturation) were monitored by a hemodynamometer. After vital signs were checked, they were sedated with a continuous infusion of dexmedetomidine or propofol after the induction with 0.01 mg/kg butorphanol and 0.05 mg/kg midazolam, and their sedation level was kept at −2 to −3 on the Richmond Agitation Score. Local anesthesia was injected at 3 minutes after the start of sedation, and 100% oxygen (3 L/min) was given via nasal cannula until 1 hour after the end of the operation. Memory of local anesthesia, auditory memory (calling for the start of sutures), and visual memory (watches, syringes, and so on shown at the end of each operation) to assess the amnesic action were evaluated. To determine the psychomotor function and recovery of equilibrium during the recovery process, the Trieger Dot Test (TDT p.e.r.) and 1-leg standing test with closed eyes (O-L test) were applied until 3 hours after the end of the operation.
Figure 2. Amnesic action at each point of implant surgery. In the comparison between the butorphanol, midazolam, dexmedetomidine (BMD) and butorphanol, midazolam, propofol (BMP) groups, there were no significant differences in the amnesic action to local anesthesia or in the auditory memory of calling for sutures at the suture onset and visual memory showing watches, syringes, and so forth at the end of each operation. Figure 3. The changes in the Trieger Dot Test plot error ratio (TDT p.e.r.). In the comparison between the BMD and BMP groups, there were no significant differences at 1 hour, 2 hours, or 3 hours after the end of the operation. However, in the BMD and BMP groups, the TDT p.e.r. at 1 hour after the end of the operation was significantly increased in comparison with each baseline value (P < .01). Figure 4. The success rate of the 1-leg standing test with closed eyes (O-L test) at 1, 2, and 3 hours after the end of the operation. A total of 5% of subjects in the BMD group and 10% of subjects in the BMP group were successful in the O-L test at 1 hour after the end of the operation. In contrast, 55% and 85% of subjects in the BMD and BMP groups successfully completed the O-L test at 2 hours after the end of the operation. All subjects in both groups could complete the O-L test at 3 hours postinfusion. At 1, 2, and 3 hours postinfusion, there were no significant differences between the 2 groups.
Figure 5. The questionnaire presented to subjects. The sensation of discomfort during the operation occurred in 10% of subjects in the butorphanol, midazolam, dexmedetomidine (BMD) group and in 15% of subjects in the butorphanol, midazolam, propofol (BMP) group. Postoperative discomfort was reported by 15% and 10% of subjects in the BMD and BMP group, respectively. In the assessment of discomfort during and after the operation, there were no significant differences between the 2 groups. For the question, “Do you want to be sedated with the same method if you have an opportunity to be sedated again?” all subjects in the BMP group answered yes, while 5% of subjects in the BMD group did not want to be sedated again using the same method. Figure 6. The questionnaire presented to surgeons. All surgeons for the BMD group replied that they could easily operate for the implant surgeries. However, 5% of surgeons for the BMP group replied that it was difficult to operate for implant surgery. When all surgeons for the BMD group were asked about their reasons for replying “yes” to the question, 65% replied that subjects did not choke during operations. Of the 95% of surgeons for the BMP group who replied “yes” to the question, 42% indicated that the reason why they answered “yes” was that the subjects did not complain of pain during the operations. Of the 5% of surgeons for the BMP group who responded “no” to the question, it was noted that the reason was that 1 of subjects frequently choked during the operation.
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