Conscious Sedation In Dentistry

Yıl 2010, Cilt: 4 Sayı: 3, 675 - 682, 01.10.2010

Sara Samur Ergüven Berrin Işık

Öz

Today, due to various reasons which result from the features of the patient or dental operation some of the dental treatment protocols can be achieved by the application of conscious sedation. The objectives of conscious sedation include reducing/elimination of anxiety, reducing unwanted movements and reactions to dental treatment, increasing patient cooperation, increasing the pain reaction threshold, increasing acceptability of the longer therapeutic procedures, reducing the gag reflex, facilitating treatment procedures in patients with mental or physical impairments or compulsive medical status and increasing effects of the sedatives. The conscious sedation process via oxygen and nitrous oxide utilization can generally be described as follows: the intended effects occur rapidly, have light level, short term, temporary and less systemic effects when compared to other sedative drugs.The purpose of this review is to give contemporary information to the reader about the definition, application fields, advantages, application techniques and points that should be taken into consideration relating to the conscious sedation technique, based on literature data

Anahtar Kelimeler

Conscious sedation, Nitrous oxide

Diş Hekimliğinde Bilinçli Sedasyon

Öz

Günümüzde diş hekimliği pratiğinde bazı uygulamalar, hastanın ya da işlemin özelliklerinden kaynaklanan nedenlerle bilinçli sedasyon altında gerçekleştirilmektedir.Bilinçli sedasyon; hastanın kaygısının azaltılması/giderilmesi, tedaviyi önleyen ya da güçleştiren hareketlerin önlenmesi, tedaviye uyumun arttırılması, ağrı reaksiyon eşiğinin yükseltilmesi, uzun tedavi prosedürlerinin kabul edilebilirliğinin arttırılması, bulantı refleksinin azaltılması, mental ve fiziksel yetersizliğe sahip hastalarda veya sistemik açıdan sıkıntılı bireylerde tedaviye yardımcı olunması ve verilen diğer sedatiflerin etkisinin arttırılması amacıyla uygulanmaktadır. Oksijenle birlikte nitröz oksit uygulanarak sağlanan bilinçli sedasyon; beklenen etkilerin kısa sürede oluştuğu, hafif seviyeli, kısa sürede geriye dönüşümlü etkilere sahip ve diğer sedatif ilaçlarla karşılaştırıldığında sistemik etkileri daha az olarak bilinen bir tekniktir. Bu derlemenin amacı; literatür bilgileri ışığında bilinçli sedasyon uygulamalarının tanımı, uygulama alanları, avantajları, uygulama tekniği ve dikkat edilmesi gereken noktalar konusunda okuyucuya güncel bilgileri vermektir

Anahtar Kelimeler

Bilinçli sedasyon, Nitröz oksit

Kaynakça

• Akarslan ZZ., Erten H. Diş hekimliği korkusu ve kaygısı. Hac Diş Hek Fak Derg. 33: 62-68, 2009.
• Locker D., Thomson WM., Poulton R. Psychological disorder, conditioning experiences, and the onset of dental anxiety in early adulthood. J Dent Res. 80: 1588-92, 2001.
• Muğlalı M., Kömerik N. Ağız cerrahisi ve anksiyete. Cumhuriyet Üniversitesi Diş Hek Fak Derg. 8: 83-88, 2005.
• Nicolas E., Collado V., Faulks D., Bullier B., Hennequin M. A national cross-sectional survey of dental anxiety in the French adult population. BMC Oral Health. 7:12, 2007.
• Marakoğlu İ., Demirer S., Özdemir D., Sezer H. Periodontal tedavi öncesi durumluk ve süreklik kaygı düzeyi. Cumhuriyet Üniversitesi Diş Hek Fak Derg. 6: 73-79, 2003.
• Kanegane K., Penha SS., Munhoz CD., Rocha RG. Dental anxiety and salivary cortisol levels before urgent dental care. J Oral Sci. 51: 515- 20, 2009.
• Humphris GM., Dyer TA., Robinson PG. The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age. BMC Oral Health. 9:20, 2009.
• Erten H., Akarslan ZZ., Bodrumlu E. Dental fear and anxiety levels of patients attending a dental clinic. Quintessence Int. 37: 304-10, 2006.
• Yusa H., Onizawa K., Hori M., Takeda S., Takeda H., Fukushima S., Yoshida H. Anxiety measurements in university students undergoing third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 98: 23-7, 2004.
• Al-Omari WM., Al-Omiri MK. Dental anxiety among university students and its correlation with their field of study. J Appl Oral Sci. 17: 199- 203, 2009.
• Sümer AP., Bodrumlu E., Sümer M., Köprülü H. Diş hekimliği öğrencileri ile diş hekimliği dışındaki diğer fakülte öğrencilerinin dental kaygılarının değerlendirilmesi. Turkiye Klinikleri J Dental Sci. 13:1-5, 2007.
• Firat D., Tunc EP., Sar V. Dental anxiety among adults in Turkey. J Contemp Dent Pract. 7: 75-82, 2006.
• Tunc EP., Firat D., Onur OD., Sar V. Reliability and validity of the Modified Dental Anxiety Scale (MDAS) in a Turkish population. Community Dent Oral Epidemiol. 33: 357-62, 2005.
• Stabholz A., Peretz B. Dental anxiety among patients prior to different dental treatments. Int Dent J. 49: 90-4, 1999.
• Wong M., Lytle WR. A comparison of anxiety levels associated with root canal therapy and oral surgery treatment. J Endod. 17: 461-5, 1991.
• Muglali M., Komerik N. Factors related to patients’ anxiety before and after oral surgery. J Oral Maxillofac Surg. 66: 870-7, 2008.
• Dionne RA., Gordon SM., McCullagh LM., Phero JC. Assessing the need for anesthesia and sedation in the general population. J Am Dent Assoc. 129: 167-73, 1998.
• Craig DC., Wildsmith JAW. Conscious sedation for dentistry: an update. Br Dent J. 203: 629-31, 2007.
• Girdler NM, Hill CM., Wilson KE. Clinical Sedation in Dentistry. UK: John Wiley & Sons Ltd. Pub., 2009, 57-103.
• Boynes SG., Lemak AL., Close JM. General dentists’ evaluation of anesthesia sedation education in U.S. dental schools. J Dent Educ. 70: 1289-93, 2006.
• Faulks D., Hennequın M., Albecker Grappe S., Manıère MC., Tardıeu C., Berthet A., Wolıkow M., Droz D., Koscıelny S., Onody P. Sedation with 50% nitrous oxide/oxygen for out patient dental treatment in individuals with intellectual disability. Dev Med Child Neurol. 49: 621-5, 2007.
• http://www.aapd.org/media/Policies_ Guidelines/G_Nitrous.pdf
• Nıcolas E., Lassauzay C. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology. Clin Interv Aging. 4: 67-72, 2009.
• Yoshida M., Nakajima I., Uchida A., Yamaguchi T., Akasaka M. Effect of nitrous oxide on dental patients with cerebral palsy -- using an electromyogram (EMG) from orofacial muscles as an index. J Oral Rehabil. 30: 324-33, 2003.
• Zacny JP., Hurst RJ., Graham L., Janıszewskı DJ. Preoperative dental anxiety and mood changes during nitrous oxide inhalation. J Am Dent Assoc., 133: 82-8, 2002.
• Ryding HA., Murphy HJ. Use of nitrous oxide and oxygen for conscious sedation to manage pain and anxiety. J Can Dent Assoc. 73: 711-711f, 2007.
• Collado V., Nicolas E., Faulks D., Tardieu C., Manière MC., Droz D., Onody P., Hennequin M. Evaluation of safe and effective administration of nitrous oxide after a postgraduate training course. BMC Clin Pharmacol. 8:3, 2008.
• Skelly M., Craig D. Sedation for dental procedures. Anaesthesia & intensive care medicine. 6: 255- 257, 2005.
• Malamed SF. Inhalation Sedation: Malamed SF, Quinn CL. Sedation A Guide to Patient Management. St. Louis: Mosby-Year Book Inc, 1995, 181-303.
• Berge TI. Nitrous oxide in dental surgery. Best Practice & Research Clinical Anaesthesiology. 15: 477-489, 2001.
• Holroyd I. Conscious sedation in pediatric dentistry. A short review of the current UK guidelines and the technique of inhalational sedation with nitrous oxide. Paediatr Anaesth. 18: 13-7, 2008.
• Hopkins PM. Nitrous oxide: a unique drug of continuing importance for anaesthesia. Best Practice & Research Clinical Anaesthesiology. 19: 381-389, 2005.
• Emmanouil DE, Quock RM. Advances in understanding the actions of nitrous oxide. Anesth Prog. 54: 9-18, 2007.
• Becker DE., Rosenberg M. Nitrous oxide and the inhalation anesthetics. AnesthProg. 55: 124-30, 2008.
• Duarte R., Mcneill A., Drummond G., Tıplady B. Comparison of the sedative,cognitive, and analgesic effects of nitrous oxide, sevoflurane, and ethanol. Br JAnaesth. 100: 203-10, 2008.
• Armstrong PJ., Morton C., Sinclair W., Tiplady B. Effects of nitrous oxide on psychological performance. A dose-response study using inhalation of concentrations up to 15%. Psychopharmacology. 117: 486-90, 1995.
• Block RI., Ghoneım MM., Hinrichs, JV., Kumar V., Pathak D. Effects of a Subanaesthetic Concentration of Nitrous Oxide on Memory and Subjective Experience: Influence of assessment procedures and types of stimuli. Human Psychopharmacology: Clinical & Experimental., 3: 257-265, 1998.
• Zacny JP., Sparacino G., Hoffmann P., Martin R., Lichtor J.L. The subjective, behavioral and cognitive effects of subanesthetic concentrations of isoflurane and nitrous oxide in healthy volunteers. Psychopharmacology. 114: 409-16, 1994.
• Norton JC., Roth GI., Matheny JL., Falace DA., O’reılly JE. The effect of nitrous oxide and age on psychological and psychomotor performance. Anesth Prog., 31: 64-9, 1984.
• Howard WR. Nitrous oxide in the dental environment: assessing the risk, reducing the exposure. J Am Dent Assoc. 128: 356-60, 1997.
• Yagiela JA. Health hazards and nitrous oxide: a time for reappraisal. Anesth Prog. 38: 1-11, 1991.
• Jastak JT, Donaldson D. Nitrous oxide. Anesth Prog.38: 142-53, 1991.
• Olfert SM. Reproductive outcomes among dental personnel: a review of selected exposures. J Can Dent Assoc. 72: 821-5, 2006.