This pilot study attempted to determine whether sevoflurane as a sole agent could be used as a deep sedative agent for minor surgical procedures in healthy young adults. Additionally, the quality of the sedation and the vital signs changes were compared with a common intravenous technique used by most dentist anesthesiologists and in many hospital and outpatient surgical facil­ities: the combination of midazolam and fentanyl followed by a propofol infusion.

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Twenty-four patients were initially enrolled in the study. One patient, a 25-year-old, 80-kg woman, developed nausea after 2 minutes of sevoflurane administration at a final vaporizer setting of 0.5%. After 3 to 4 minutes, her feeling of nausea subsided. The patient was withdrawn from the study. A conscious sedation was then planned and 10 mg of diazepam was slowly titrated. Shortly thereafter, the patient reported that she felt more relaxed but she again became nauseated and vomited. After emesis of a small volume of gastric liquid, 25 mg of promethazine was titrated. Nausea was relieved and the patient felt she could proceed with her planned surgery, which was carried out uneventfully.

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After approval from the Ohio State University Human Subjects Review Committee, 24 patients (17 women and 7 men) were enrolled in the study. All patients were American Society of Anesthesiologists (ASA) Physical Status I or II and between 18 and 40 years of age. Patients who were currently using benzodiazepines, antidepressants, or long-term analgesics were excluded from the study. Likewise, patients with a recent history of renal disease or documented coronary artery disease were excluded from the study. Any patients that were ASA status III or higher, prisoners or wards of the state, minors, mentally retarded or developmental^ disabled, pregnant or actively trying to become pregnant, or nursing were also excluded. All patients presented to the Department of Oral and Maxillofacial Surgery outpatient clinic for evaluation of removal of at least 3 impacted third molars. A health history was obtained, a videotape explaining the proposed surgery was viewed by each subject, an examination and consultation was performed, and a written consent for surgery and sedation was obtained. Once the patients decided to proceed with surgery, they were advised of the possibility of enrolling in the present study. For those patients who decided to participate, a separate human review committee-approved consent form was also reviewed and signed. The patients were reappointed for surgery at a later date.

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The use of the conscious inhalation sedative nitrous oxide has a long history of success and safety in the dental office provided that supplemental oxygen is administered. Nitrous oxide-oxygen inhalation sedation has a rapid onset and recovery, provides varying degrees of analgesia, and has minimal respiratory, cardiovascular, and other adverse effects. This is likely the most common form of sedation performed by dentists today. Unfortunately, this technique does not always provide adequate sedation for all dental patients who need it. Alternative techniques, such as intravenous sedation, have therefore been developed.

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