Intravenous sedation useful for dental patients with severe dementia, finds Study

Therefore, Hitomi Nishizaki and colleagues from the Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan conducted a retrospective cohort study of a Japanese population to analyze the effectiveness of intravenous sedation for dental treatment in elderly patients with severe dementia.

The authors obtained the patients' characteristics and type of dementia from medical records. Nineteen patients with severe dementia who underwent 62 instances of sedation were included. Midazolam (MID), dexmedetomidine (DEX), and propofol (PRO) were administered as sedatives. The systolic blood pressure (SBP), heart rate (HR), SpO2, bispectral index (BIS) values and complications were evaluated.

The following key findings were noted-

a. The sedation time and permission time to return home were significantly longer in DEX than in MID or PRO group.

b. Half the usual dose in MID and lower limits of the routine dose was effective in DEX and PRO.

c. HR was significantly lower in DEX group.

d. There were 3 cases with airway obstruction requiring nasopharyngeal airway and 4 cases of apnea when MID was administered.

e. Two cases of Cheyne-Stokes-like respiration when MID or DEX was administered.

f. SpO2 <94% was found in 22 cases (35%) irrespective of the sedative.

g. A patient with dementia with Lewy bodies had experienced hallucinations during the recovery period after sedation when MID or DEX was administered.

h. The BIS value of ≤80 was noted during complications.

Hence, it was concluded that "intravenous sedation for dental treatment in the elderly with severe dementia, needs a dose titration. All sedatives had respiratory-related complications which mandate close monitoring."