title: Effects of implant surgery on blood pressure and heart rate during sedation with propofol and midazolam.
abstract: OBJECTIVE
  Intravenous (IV) sedation is commonly used in dentistry. However, no report has yet been published regarding age, hypertension, and antihypertensive drugs during implant surgery and their relationship with changes in blood pressure (BP) and heart rate in implant surgery under IV sedation with propofol and midazolam.
  
  
  METHODS
  Medical records of 252 patients who underwent implant surgery were retrospectively analyzed. Patients were classified into four groups according to their age (in years) and hypertension status: A=≤64, no hypertension; B=≥65, no hypertension; C=≤64, hypertension; or D=≥65, hypertension. Hypertensive patients were further characterized by their antihypertensive medications: E=calcium channel blockers (CCBs), F=angiotensin II receptor blockers (ARBs), G=CCBs+ARBs, or H=no medication. IV sedation was administered in two stages. After midazolam injection to prevent angialgia, propofol was infused at the rate of 4 mg/kg/h, followed by a dose reduction. Systolic and diastolic BP and heart rate were recorded before, during, and after surgery.
  
  
  RESULTS
  Systolic BP increased significantly after patients were draped in groups A, C, and D, with group D showing the most pronounced increase. Sedatives decreased BP in all groups. Diastolic BP in group F decreased significantly compared to group H after induction and before infiltration of local anesthetic. After infiltration, systolic BP decreased more significantly in group G than in group H. Intraoperative hypotension was observed in 25% of patients. The incidence of intraoperative hypertension in group D was markedly higher than in group A (23% vs 4%).
  
  
  CONCLUSIONS
  IV sedation using midazolam and propofol reduces hypertensive risks during implant surgery. Nevertheless, care must be taken, especially in older hypertensive patients and in hypertensive patients on ARBs or ARBs+CCBs.
authors.affiliation: Unit of Oral and Maxillofacial Implantology, Department of Internal Medicine, Tsurumi University School of Dental Medicine, Yokohama, Japan. ueno-d@tsurumi-u.ac.jp
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ueno
authors.forename: Junichi
authors.initials: J
authors.lastname: Sato
authors.forename: Jun
authors.initials: J
authors.lastname: Nejima
authors.forename: Keisuke
authors.initials: K
authors.lastname: Maruyama
authors.forename: Mariko
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Iketani
authors.forename: Rei
authors.initials: R
authors.lastname: Sekiguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawahara
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003757:Dental Implantation; D005260:Female; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008874:Midazolam / Q000494:pharmacology*; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol