title: Cough reflex under intravenous sedation during dental implant surgery is more frequent during procedures in the maxillary anterior region.
abstract: OBJECTIVE
  The present study was performed to evaluate the incidence of cough episodes and the association between cough episodes and patient-related and site-specific parameters during implant surgery when performed under intravenous sedation.
  
  
  METHODS
  One hundred forty-seven patients scheduled for dental implant surgeries under intravenous sedation were enrolled in this study. Heart rate, blood pressure, percutaneous oxygen saturation, and bispectral index were monitored. Sedation was induced intravenously by a bolus administration of midazolam and maintained by a continuous administration of propofol. Sedation level was adjusted to achieve scores of 3 to 4 on the Ramsay Sedation Scale. Surgical procedures were divided into 11 stages. Implant sites were labeled as right maxillary molar, maxillary anterior, left maxillary molar, right mandibular molar, mandibular anterior, and left mandibular molar sites. When coughing occurred, heart rate, blood pressure, percutaneous oxygen saturation, bispectral index, procedure being performed, and surgical site being stimulated were recorded.
  
  
  RESULTS
  One hundred seventy-two cough episodes were observed in 97 patients (66%). Cough episodes occurred during all stages of surgery but were substantially more frequent during preparation of the implant site. The incidence of cough episodes was significantly higher at the maxillary anterior site and lowest at the right mandibular molar areas.
  
  
  CONCLUSIONS
  These findings suggest that difficulties in swallowing and in the suction of intraoral fluids have variable effects at different surgical sites. Careful suction of intraoral water and an appropriate sedation level are required, especially in procedures in the maxillary anterior region.
authors.affiliation: Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan. hanamoto@dent.osaka-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hanamoto
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Sugimura
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Chiho
authors.initials: C
authors.lastname: Kudo
authors.forename: Aiji
authors.initials: A
authors.lastname: Boku
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Niwa
mesh_terms: D000368:Aged; D000766:Anesthesia, Dental / Q000379:methods; D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D016009:Chi-Square Distribution; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods; D003371:Cough / Q000209:etiology / Q000503:physiopathology*; D003481:Cuspid; D003758:Dental Implantation, Endosseous / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007180:Incisor; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage; D012018:Reflex / Q000502:physiology; D018709:Statistics, Nonparametric
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol