Date of Award

1999

Document Type

Thesis - Restricted

Degree Name

Master of Science (MS)

Department

Dentistry

First Advisor

Ellinger, Royal

Second Advisor

Osmon, C. David

Third Advisor

Dentino, Andrew

Abstract

Fear and anxiety over the prospect of dental treatment are sufficient reasons for many people to avoid visiting the dentist. With the advent of local anesthesia, most procedures can be completed quickly and comfortably. Even more complex surgical procedures are routinely done with local anesthesia alone, although many patients still avoid treatment unless they can be "put to sleep". Dentists are constantly seeking methods to improve patient comfort while providing more efficient delivery of care. Intravenous conscious sedation safely and effectively reduces fear and anxiety associated with dental treatment while allowing the clinician to treat the patient more efficiently. Periodontists, oral surgeons and dental anesthesiologists are dental specialists who use intravenous conscious sedation more frequently than other dental professionals. Depending on the procedure, the periodontist may require from one to three hours of sedation compared to the oral surgeon who usually requires an hour or less to complete more routine procedures such as third molar extractions. Much has been published about the effects of intravenous conscious sedation during oral surgical procedures and recovery thereafter, but little literature exists concerning recovery from sedation following periodontal surgery. The patient's psychomotor and cognitive status following the procedure may be different after a two or three hour surgery versus a one hour surgery because more medication is generally needed intraoperatively during the longer surgery. Techniques of sedation vary among clinicians and the type and amount of medication used is determined by the level of sedation deemed "adequate" by the doctor. The technique used for this study involves slow intravenous titration of midazolam, a benzodiazepine sedative-hypnotic, and meperidine, an opioid agonist. The opioid provides analgesia, slight euphoria, and enhanced sedation. During the surgery, additional midazolam is frequently administered in 0.5 mg increments at the discretion of the surgeon if deeper sedation is indicated. Because of the psychotropic nature of these medications, behavioral and neuropsychological issues warrant further evaluation. In this study, the test patient was asked to perform two separate tasks. The first task measured the patient's psychomotor and cognitive function with a computer-based program that tests reaction time. The second task used a finger-tap counter device to determine the patient's fine motor control. The patient performed both tasks at three separate time intervals during the course of the appointment: prior to administering medications, immediately after the surgery was completed, and thirty minutes later. The purpose of the present study was to evaluate and compare psychomotor and cognitive function in patients during the recovery period following intravenous conscious sedation for periodontal surgery. Specifically, the relationship between midazolam and scores on manual and computer-based reaction time tests was analyzed. In addition, it was determined whether or not there was a significant difference in reaction time scores immediately after surgery and thirty minutes later. This information can be used as a guideline to supplement other parameters that aid the clinician in determining when the periodontal patient is ready to be released from professional supervision in the company of an escort.

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