title: Considerations during intravenous sedation in geriatric dental patients with dementia.
abstract: OBJECTIVE
  We retrospectively assessed the usability and precautions required during intravenous sedation (IVS) for dental treatment in geriatric outpatients with dementia.
  
  
  METHODS
  We investigated the intraoperative complications in 65 cases (25 geriatric dental patients with dementia) under IVS, from the standpoint of local anesthesia usage, water usage during treatment, and content of treatment.
  
  
  RESULTS
  Circulatory complications occurred in 46.2 % and respiratory complications in 52.3 % of all cases (n = 65). Bradycardia occurred in 13.8 % and hypotension in 12.3 % of cases in the former, while coughing spells occurred in 41.5 % and snoring in 16.9 % of cases in the latter. Many of the local anesthesia usage cases did not require water usage, such as during tooth extraction (p < 0.0001). Water usage cases, such as for caries treatment, needed longer sedation and treatment times, resulting in more propofol usage (p < 0.001, p < 0.0001, and p < 0.01, respectively). Many coughing spells developed in the water usage cases (p < 0.05). 81.8 % of snoring and 63.3 % of circulatory complications, such as hypotension and bradycardia, developed in the tooth extraction cases (p < 0.05).
  
  
  CONCLUSIONS
  All the scheduled dental treatments in dementia patients were smoothly performed under IVS. However, stringent attention should be paid to the prevention of aspiration of fluids retained in the pharynx, airway obstruction due to therapeutic maneuvers, respiratory inhibition by sedatives, and hemodynamic fluctuations caused by invasive procedures under local anesthesia.
  
  
  CONCLUSIONS
  In the future, with the growing need for dental procedures in dementia patients, dentists will require training in the general management of such patients.
authors.affiliation: Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan, smit@dent.osaka-u.ac.jp.
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Sugimura
authors.forename: Chiho
authors.initials: C
authors.lastname: Kudo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hanamoto
authors.forename: Aiko
authors.initials: A
authors.lastname: Oyamaguchi
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Aiji
authors.initials: A
authors.lastname: Boku
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Niwa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000766:Anesthesia, Dental / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods*; D003704:Dementia; D016321:Dental Care for Aged / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies
chemical_list: D018686:Anesthetics, Intravenous