Sedación Oral Consciente en Cirugía Ortognática
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Protocolo estandarizado de sedación oral consciente.Las drogas más comúnmente empleada son las benzodiacepinas, La más usada de todas para sedación-anlagesia es el Midazolam (Doricum,Dormicum,Versec) Con mucha frecuencia los pacientes son sometidos a procedimientos "menores", muchos de ellos dolorosos, sin sedación o analgesia. El dolor y la ansiedad deben ser abolidos, no solo por razones éticas y humanitarias, sino también para evitar la respuesta fisiopatológica al dolor.
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Sedación Oral Consciente en Cirugía Ortognática
- 1. STANDARDIZED PROTOCOL FOR THE USE OF ORAL MIDAZOLAM Dr. Samuel Benarroch MD, DDS, MS Assistant Professor Oral & Maxillofacial Surgery Residency Program Woodhull Medical Center. New York Hospital Magallanes de Catia. Caracas
- 2. ANXIOLYSIS & SEDATION
- 3. PURPOSE Assess the safety and effectiveness of an oral anxiolysis sedation protocol for adults by means of a standardized midazolam dose for dental treatments and ambulatory maxillofacial surgery
- 5. PATIENT DISTRIBUTION SEX SEX NUMBER % MALE 83 24.20 FEMALE 260 75.80 TOTAL 343 100
- 6. PATIENT DISTRIBUTION AGE AGE NUMBER % 15 – 20 138 40.23 21 – 30 163 47.29 31 – 40 28 8.05 41 – 50 8 2.47 > 50 6 2.05 TOTAL 343 100
- 7. PATIENT DISTRIBUTION WEIGHT WEIGHT NUMBER % 55 – 59 43 12.5 60 – 64 128 37.3 65 – 69 94 27.4 70 – 74 49 14.3 > 75 29 8.5 TOTAL 343 100
- 8. PATIENT DISTRIBUTION Physical Status Classification ASA NUMBER % ASA I 295 75.80 ASA II 48 24.20 TOTAL 343 100
- 9. PATIENT DISTRIBUTION SURGICAL PROCEDURES PROCEDURE NUMBER % ORAL SURGERY 329 95.92 COSMETIC SURGERY 14 4.08 TOTAL 343 100
- 10. PATIENT DISTRIBUTION ORAL SURGERY
- 11. PATIENT DISTRIBUTION ORAL SURGERY
- 12. PATIENT DISTRIBUTION ORAL SURGERY PROCEDURES NUMBER % THIRD MOLAR EXTRACTION 4 180 54.7 MULTIPLES DENTAL EXTRACTIONS 45 13.7 MULTIPLE IMPLANTS SURGERY 67 20.4 PREPROSTHETIC SURGERY 24 7.2 OTHER 13 4 TOTAL 329 100
- 15. PATIENT DISTRIBUTION COSMETIC SURGERY
- 16. PATIENT DISTRIBUTION COSMETIC SURGERY
- 17. PATIENT DISTRIBUTION COSMETIC SURGERY
- 18. PATIENT DISTRIBUTION COSMETIC SURGERY PROCEDURES NUMBER % GENIOPLASTY 7 50.3 RHINOPLASTY 3 21.3 BLEPHAROPLASTY 2 14.2 FACIAL LIPOSUCTION 1 7.1 Mini lifting 1 7.1 TOTAL 14 100
- 32. POST SURGERY IMMEDIATE ANXIETY CONTROL 10 minutes after surgery No anxiety 56.4 % Mild anxiety but tolerable 18.5 % Moderate anxiety but tolerated 16.9 % Moderate anxiety not controlled by prescribed drug 5.1 % Severe anxiety not controlled by prescribed drug 3.1%
- 35. THANK YOU STANDARDIZED PROTOCOL FOR THE USE OF ORAL MIDAZOLAM Dr. Samuel Benarroch MD, DDS, MS Assistant Professor Oral & Maxillofacial Surgery Residency Program Woodhull Medical Center. New York Hospital Magallanes de Catia. Caracas
Notas del editor
- Routine dental and maxillofacial surgery are commonly undertaken on a day case basis. Pain and anxiety are the most common complaints referred by patients Analgesia and Anxiolysis: are mandatory for today’s practice Health professionals have used oral medications for many years to relieve fear and apprehension associated with dental and medical treatments Oral premedication and sedation with benzodiazepines are widely used in Medicine
- The purpose of this paper is to assess the safety and effectiveness of an oral anxiolysis sedation protocol for adults by means of an initial standardized midazolam dose for dental treatments and ambulatory maxillofacial surgery.
- Multiple centers retrospective study conducted from 1998 to 2004
- A total of 343 patients were included in the study, 260 females and 83 males.
- The mean age was 23.5 years
- mean weight was 69.6 Kgs
- Every patient was evaluated considering risk factors and underwent a complete medical physical examination. 295 ASA I 48 Asa II ASA II Hipertention 32 Diabetes were the pathologies in the asa II group
- The patients were referred for oral and cosmetic surgery
- All the surgical units and surgeons had the same protocols in terms of
- fear, stress and anxiety were the mainly reason to indicate the protocol
- All the patients underwent a complete physical and medical evaluation and special attention was given to the no liquid intake 4 hours prior the surgery and no solid intake 6 hour prior the surgery
- All the surgical units have the same monitoring capabilities
- Heart rate and oxygen saturation were continuously monitored. Respiratory rate and blood pressure were monitored and documented every 5 minutes Length and type of surgery were recorded.
- All considerations were taken to discharge the patient fully stable
- Post sedation indication are given to the person in charge of the patient, outside the surgical facilities
- The anxiolysis sedation protocol consists in two phases, oral premedication 90 minutes prior to the surgery (midazolam 7,5 mg, unique dose) and posterior oral sedation (midazolam, 0.20 mg/kg) 30 minutes prior to the anaesthesia infiltration.
- Anxiety control is one of the aim variables to measure and record Levels of anxiety are addressed 30 minutes pre-operative , immediate post-operatively and at the moment to discharge the patient
- The anxiety scale that we use gives points to the level of anxiety at 3 different moments with special attention in the effectiveness of the drug
- In terms of 87 % of the patients, no to mild anxiety was referred, 30 minutes prior to surgery
- The anxiety at the end of the surgery shows an increase in the levels, in the moderate but tolerated group and in the not controlled group
- Levels of anxiety and effectiveness of the medication after 1 hour showed that 96 % of the patients were among the no anxiety or tolerable groups and only 4 % were unsatisfied with the protocol medication proposed