Analysis of an anxiolytic technique applied in 1179 patients undergoing oral surgery.
OBJECTIVE
The aim of this study was to evaluate the effects of sedation with benzodiazepines in a large population of patients undergoing oral surgery and age-related implications.


METHODS
A group of 1 179 consecutive patients undergoing oral surgery in the Dental Clinic of the University of Padua between 2001 and 2003 was evaluated by analysing their anaesthesiological records. The patients were divided into 5 age groups. All were pre-sedated with chlordemethyldiazepam per os, while induction of maximum subjective tranquillity was obtained with fractionated doses of intravenous diazepam. Arterial pressure (AP), heart rate (HR), anxiety level, pathologies, drugs taken, types of intervention, techniques of loco-regional anaesthesia, immediately preoperative AP and HR and tranquillity, intraoperative AP and HR, data regarding postoperative psychomotor recovery, complications and drugs used for the treatment of perioperative pain, were evaluated in each group.


RESULTS
Most of the patients (679) were in the 45-64 year-old group. Cardiovascular, respiratory and digestive pathologies proved to be age-dependent. Control AP and HR respectively increased and decreased with age. The doses of chlordemethyldiazepam used induced age-dependent preoperative tranquillity levels. The doses of i.v. diazepam necessary to obtain maximal preoperative subjective tranquillity fell as a function of age. The AP and HR values respectively increased during intervention and decreased in the first hour of intervention. Normal psychomotor recovery was less evident in older patients. The most significant corrective intraoperative interventions consisted of the administration of sublingual hypotensive drugs and in the immediate treatment of some cases of orthostatic hypotension and vaso-vagal syncope.


CONCLUSIONS
The sedation technique and the antistress procedures employed proved safe and the intra- or postoperative complications almost non-existent. The variations observed in the parameters considered are compatible with the greater age of the treated subjects.
Manani
G
G
Course on Sedation Urgency and Emergency in Odontostomatology, Section of Clinical Dentistry, Department of Medico-Surgical Specialties, University of Padua, Padua, Italy. gmanani@supereva.it
Alberton
L
L
Bazzato
M F
MF
Berengo
M
M
Da Corte Zandatina
S
S
Di Pisa
A
A
Favero
G
G
Favero
G
G
Floreani
S
S
Guarda-Nardini
L
L
Mazzuchin
M
M
Parolin
P
P
Sivolella
S
S
Stellini
E
E
Tonello
S
S
Zanette
G
G
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures
D014151:Anti-Anxiety Agents; D003975:Diazepam