title: Non-randomized controlled prospective study on perioperative levels of stress and dysautonomia during dental implant surgery.
abstract: OBJECTIVE
  The purpose of this study was to compare pre- and postoperative autonomic activities and changes in salivary stress biomarkers between patients who received only local anesthesia and those who received local anesthesia together with intravenous sedation in dental implant surgery.
  
  
  METHODS
  A total of 21 patients were enrolled in this non-randomized controlled prospective study; 7 subjects underwent implant surgery under local anesthesia with intravenous sedation and 14 subjects underwent surgery under only local anesthesia. Stress was evaluated by measuring salivary levels of chromogranin A (CgA) and a spectral analysis of heart rate variability (HRV) at baseline (on a day other than the day of surgery), 1h preoperatively, and 1h postoperatively. HRV analysis yields low- (LF) and high-frequency (HF) components, the LF/HF ratio, and the component coefficient of variance (CCV[HF]), which provide indices of sympathetic and parasympathetic regulatory activity.
  
  
  RESULTS
  CgA levels were significantly higher (p<0.05) at baseline in patients who received sedation than those who did not, but CgA levels did not differ prior to surgery. Also, the values of most parameters, including LF, HF, LF/HF (L/H), and CCV(HF), did not significantly differ between groups or among the three time points. Only ΔL/H and ΔCCV(HF) were significantly lower (p<0.05) at 1h preoperatively in patients who received sedation than those who received only local anesthesia.
  
  
  CONCLUSIONS
  CgA levels were high in both groups immediately before surgery, and thus CgA values immediately before surgery may not be a reliable indicator of the need for intravenous sedation. Also, spectral analysis of HRV, especially ΔL/H and ΔCCV(HF), could be useful for assessing tension and anxiety.
authors: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan.
authors: Miyuki
authors: M
authors: Morino
authors: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan.
authors: Chihiro
authors: C
authors: Masaki
authors: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan.
authors: Yoshinori
authors: Y
authors: Seo
authors: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan.
authors: Chisato
authors: C
authors: Mukai
authors: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan.
authors: Taro
authors: T
authors: Mukaibo
authors: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan.
authors: Yusuke
authors: Y
authors: Kondo
authors: Department of Dental Anesthesiology, Kyushu Dental University, Japan.
authors: Shunji
authors: S
authors: Shiiba
authors: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan.
authors: Tetsuji
authors: T
authors: Nakamoto
authors: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan. Electronic address: hosokawa@kyu-dent.ac.jp.
authors: Ryuji
authors: R
authors: Hosokawa
mesh_terms: D000772:Anesthesia, Local; D015415:Biomarkers / Q000032:analysis; D053379:Chromogranin A / Q000032:analysis*; D016854:Dental Anxiety / Q000175:diagnosis*; D003757:Dental Implantation / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D054969:Primary Dysautonomias / Q000175:diagnosis* / Q000209:etiology*; D011446:Prospective Studies; D012463:Saliva / Q000378:metabolism; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology*
chemical_list: D015415:Biomarkers; D053379:Chromogranin A; D006993:Hypnotics and Sedatives
keywords: Autonomic reflexes; Implant surgery; Intravenous sedation; Psychological stress