title: Risk factors with intravenous sedation for patients with disabilities.
abstract: The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO2) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO2 <90% and a recovery period of >60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003-7.978; 95% confidence interval; P < .001). Decision tree analysis showed an increased risk of decreased SpO2 in males with Down syndrome or after administration of >0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered >0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO2. In addition, delayed recovery is expected after midazolam administration.
authors.affiliation: Section of Anesthesiology and Clinical Physiology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Yoshikawa
authors.forename: Yoh
authors.initials: Y
authors.lastname: Tamaki
authors.forename: Hisa
authors.initials: H
authors.lastname: Okumura
authors.forename: Zenzo
authors.initials: Z
authors.lastname: Miwa
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Shimoyama
authors.forename: Zenkou
authors.initials: Z
authors.lastname: Nakamura
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kunimori
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Jinno
authors.forename: Hikaru
authors.initials: H
authors.lastname: Kohase
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Fukayama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000009:adverse effects* / Q000379:methods; D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D019162:Anesthetics, Combined / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D002547:Cerebral Palsy; D002648:Child; D003663:Decision Trees; D054810:Deep Sedation / Q000009:adverse effects* / Q000379:methods; D003730:Dental Care for Persons with Disabilities; D004314:Down Syndrome; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008607:Intellectual Disability; D016015:Logistic Models; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D008875:Middle Aged; D009609:Nitrous Oxide; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D009609:Nitrous Oxide; D008874:Midazolam; D015742:Propofol