The Effects of Preoperative Anxiety on Intravenous Sedation. METHODS

In: Health

15 Sep 2009

Twenty-five patients of American Society of Anesthesiologists’ classification I or II undergoing extraction of at least 2 impacted third molars were studied. Before sedation, patients completed the Spielberger State Trait Anxiety Inventory (STAI). The investigators were blinded to the results of the STAI until after the patient wasdismissed. The scores were then compared with tables of normative data obtained through previous studies of working adults, college students, high school students, and military recruits. During the procedure, bispectral (BIS) analysis was used to maintain a constant depth of sedation at a clinically acceptable level, which was determined from previous studies and by the present researchers to be at a level corresponding to a BIS reading of 70-80.

After preoperative vital signs were recorded, intravenous access was obtained and lactated Ringer’s intravenous fluid started, as well as oxygen administration via nasal hood at 3 L/min. Initially, midazolam in 1-mg intravenous boluses was given until the Verrill sign (bilateral upper eyelid ptosis) was achieved (dose is approximately 0.05 mgAg of lean body weight). Fentanyl was given in 50-|xg boluses for a total of approximately 1.5 jjugAg of lean body weight. Propofol was then given in 10- to 20-mg boluses until a clinically desirable sedation level was achieved (BIS level of 70-80). The total amount of medications given and the time were recorded. Additional sedative-hypnotic agents (midazolam and/or propofol) were administered to maintain a BIS level of 70-80. The time and dose of the bolus given were recorded to study the effect of these additional boluses on the indices.  Beat the drug companies and buy viagra plus online

All patients had preoperative baseline and continuous intraoperative vital signs monitored with pulse oximetry, precordial stethoscope, automated and continuous noninvasive blood pressure measurements using the Vaso-trac (Medwave, St Paul, Minn), electrocardiogram, and respiratory rate. Changes in vital signs, such as elevation of blood pressure or pulse, and evidence of patient movement were used as markers of potential stress-related pain or other source of intraoperative stimulation. Episodes of patient movement were graded subjectively with the behavior grading scale (Table) at times of unwanted patient movement and when medications were administered. Each patient had a different number of episodes graded based on the patient’s degree of movement throughout the procedure and the frequency of drug administration. The grading was performed by the Based on STAI scores, subjects were divided into high- and low-anxiety groups; patients with a state anxiety score of 50 or more were considered to have a high level of preoperative anxiety. In one analysis, we considered whether there was a difference in the dose of propofol administered to patients with state anxiety scores of 50 or more and those with state anxiety scores of 49 or less. We also considered whether there was a difference in the degree of intraoperative movement in subjects with high-state (^50) versus low-state anxiety. We then considered state and trait anxiety as continuous predictors of the total dose requirement of propofol and continuous predictors of the degree of average intraoperative movement. Statistical analysis of results was calculated using the standard t test and linear regression analysis. order fosamax

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.


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