Moderate sedation for complex oral surgical procedures in the dental clinic

Abstract

Context: Intravenous sedation has become vastly employed in dental offices to manage anxiety and pain during surgical procedures. Several guidelines have focused on patient evaluation, safety of agents used, credentialling of operators, acquisition of resuscitative skills.
Objective: To assess the safety and application of the principles of moderate sedation in the management of complex maxillofacial surgical procedures in the dental office setting.
Study design: Jaw resection was carried out in six patients who are ASA I and II with histologically intramuscular benign jaw lesions in the dental office under a combination of intravenous diazepam, intramuscular pentazocine and lidocaine containing epinephrine infiltration and nerve block. Serial measurements of blood pressure, pulse rate, respiratory rate and pulse oximetry was done at baseline and every 15 minutes until wound closure. Blood loss and patients pain recall after the procedure was measured.
Results: Male and female were of equal proportion with a mean age of 29.3 ± 5.8 years. Four had mandibular surgery while two had maxillary procedures. The mean blood loss was 208.3 ± 115.8ml. Although there were variations in the SBP, DBP, PR, RR and SpO2 during the surgery, they all were within the physiologic range. There was no association between SBP, DBP, PR, RR and SpO2 and perioperative time (p>0.05)
Conclusion: Moderate sedation by the administration of diazepam and pentazocine is safe for invasive jaw procedures in the dental office in patients ASA I and II. We however suggest accreditation of dental anaesthesiology in the postgraduate medical colleges for proper credentialling of dentists.