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Turer OU, Ozcan M, Alkaya B, Demirbilek F, Alpay N, Daglioglu G, Seydaoglu G, Haytac MC. The effect of mindfulness meditation on dental anxiety during implant surgery: a randomized controlled clinical trial. Sci Rep 2023; 13:21686. [PMID: 38066232 PMCID: PMC10709419 DOI: 10.1038/s41598-023-49092-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
Dental implant surgery is almost always associated with patient anxiety. Anxiety during dental surgical procedures triggers an increase in sympathetic activity. Mindfulness meditation (MM) is often associated with high levels of relaxation in the form of increased parasympathetic tone and decreased sympathetic activity. However, the effect of MM on dental anxiety is not clear. The current study aimed to show the effects of a MM as a sedative technique during dental implant surgery by examining the State-Trait Anxiety Inventory (STAI-S), bispectral index (BIS), cortisol levels (CL), systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and saturation (SpO2) parameters. HR, SBP, DBP, SpO2, BIS score and CLs were compared at the baseline, immediately before-, during-, and immediately after surgery between the test and control groups. We found that the MM resulted in significant decrease in BIS together with positive effects on hemodynamic parameters (decrease of HR, SBP, DBP and increase of SpO2), psychological findings (improvement on STAI-S scores) and biochemical outcomes (decreased CL). In conclusion, the results demonstrate that MM appeared to be a reliable strategy for managing stress during dental implant operation with benefits in psychological, physiological and biochemical outcomes.
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Affiliation(s)
- Onur Ucak Turer
- Department of Periodontology, Faculty of Dentistry, Cukurova University, Adana, Turkey.
| | - Mustafa Ozcan
- Department of Periodontology, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Bahar Alkaya
- Department of Periodontology, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Furkan Demirbilek
- Department of Periodontology, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Nilgun Alpay
- Department of Anesthesiology and Reanimation, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Gulcin Daglioglu
- Department of Medical Biochemistry, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gulsah Seydaoglu
- Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - M Cenk Haytac
- Department of Periodontology, Faculty of Dentistry, Cukurova University, Adana, Turkey
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Shafi RI, Goswami M, Rahman B, Nangia T, Nisa TU, Chawla S. Comparative Evaluation of Changes in Physiological and Psychomotor Effects in Pediatric Patients during Extraction under Different Concentrations of Nitrous Oxide-Oxygen Inhalation Sedation. Contemp Clin Dent 2021; 12:414-418. [PMID: 35068842 PMCID: PMC8740795 DOI: 10.4103/ccd.ccd_416_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/22/2020] [Accepted: 09/27/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Nonpharmacological behavioral management techniques are routinely used to create an environment that facilitates and builds a rapport between the child and the dentist to carry out procedures with minimal disruption. However, the discomfort associated with oral injections produces varying degrees of stress in all patients. Nitrous oxide (N2O)–oxygen (O2) inhalation sedation is one of the most widely used modalities for the management of fear and anxiety in children. Objective: The objective was to evaluate changes in physiological and psychomotor effects in pediatric patients during extraction under different concentrations of N2O–O2 inhalation sedation. Materials and Methods: A total of 300 healthy patients in the age range of 6–12 years (mean 8.9 years), who needed extraction of primary tooth, were included in the study. Pulse rate, SpO2, blood pressure (BP), and temperature were recorded at baseline, 30% N2O concentration, 50% N2O concentration, and again postoperatively. In addition, anxiety levels and neuromuscular coordination were recorded at the respective intervals. Results: The results revealed a mean decrease in pulse rate and BP from baseline and an increase in temperature and O2 saturation during the sedation procedure. The findings were statistically significant. Significant impairment of coordination and psychomotor ability was seen at each step. Anxiety had significantly reduced after the onset of sedation due to the anxiolytic effect of N2O. Conclusion: N2O–O2 inhalation sedation under different concentrations reduces the anxiety of the patient and produces adequate sedation with vital signs within normal limits along with temporary impairment of psychomotor ability and coordination.
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Affiliation(s)
- Reshi Iram Shafi
- PG Student, Department of Pediatric and Preventive Dentistry, ITS Dental College, Hospital and Research Centre Greater, Noida, India
| | - Mousumi Goswami
- Prof and Head, Department of Pediatric and Preventive Dentistry, ITS Dental College, Hospital and Research Centre Greater, Noida, India
| | - Bushra Rahman
- Senior Lecturer, Department of Pediatric and Preventive Dentistry, ITS Dental College, Hospital and Research Centre Greater, Noida, India
| | - Tanu Nangia
- Reader, Dept of Pediatric and Preventive Dentistry, ITS Dental College, Hospital and Research Centre Greater, Noida, India
| | - Tauqeer Ul Nisa
- PG Student, Department of Pediatric and Preventive Dentistry, ITS Dental College, Hospital and Research Centre Greater, Noida, India
| | - Sakshi Chawla
- PG Student, Department of Pediatric and Preventive Dentistry, ITS Dental College, Hospital and Research Centre Greater, Noida, India
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Sandhu G, Khinda PK, Gill AS, Singh Khinda VI, Baghi K, Chahal GS. Comparative evaluation of stress levels before, during, and after periodontal surgical procedures with and without nitrous oxide-oxygen inhalation sedation. J Indian Soc Periodontol 2017; 21:21-26. [PMID: 29386796 PMCID: PMC5767984 DOI: 10.4103/jisp.jisp_226_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/27/2017] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Periodontal surgical procedures produce varying degree of stress in all patients. Nitrous oxide-oxygen inhalation sedation is very effective for adult patients with mild-to-moderate anxiety due to dental procedures and needle phobia. AIM The present study was designed to perform periodontal surgical procedures under nitrous oxide-oxygen inhalation sedation and assess whether this technique actually reduces stress physiologically, in comparison to local anesthesia alone (LA) during lengthy periodontal surgical procedures. SETTINGS AND DESIGN This was a randomized, split-mouth, cross-over study. MATERIALS AND METHODS A total of 16 patients were selected for this randomized, split-mouth, cross-over study. One surgical session (SS) was performed under local anesthesia aided by nitrous oxide-oxygen inhalation sedation, and the other SS was performed on the contralateral quadrant under LA. For each session, blood samples to measure and evaluate serum cortisol levels were obtained, and vital parameters including blood pressure, heart rate, respiratory rate, and arterial blood oxygen saturation were monitored before, during, and after periodontal surgical procedures. STATISTICAL ANALYSIS USED Paired t-test and repeated measure ANOVA. RESULTS The findings of the present study revealed a statistically significant decrease in serum cortisol levels, blood pressure and pulse rate and a statistically significant increase in respiratory rate and arterial blood oxygen saturation during periodontal surgical procedures under nitrous oxide inhalation sedation. CONCLUSION Nitrous oxide-oxygen inhalation sedation for periodontal surgical procedures is capable of reducing stress physiologically, in comparison to LA during lengthy periodontal surgical procedures.
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Affiliation(s)
- Gurkirat Sandhu
- Department of Periodontology and Oral Implantology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Paramjit Kaur Khinda
- Department of Periodontology and Oral Implantology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Amarjit Singh Gill
- Department of Periodontology and Oral Implantology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Vineet Inder Singh Khinda
- Department of Pedodontics and Preventive Dentistry, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Kamal Baghi
- Department of Medicine, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Gurparkash Singh Chahal
- Department of Periodontology and Oral Implantology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Chandigarh, India
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Myocardial Dysfunction and Shock after Cardiac Arrest. BIOMED RESEARCH INTERNATIONAL 2015; 2015:314796. [PMID: 26421284 PMCID: PMC4572400 DOI: 10.1155/2015/314796] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
Postarrest myocardial dysfunction includes the development of low cardiac output or ventricular systolic or diastolic dysfunction after cardiac arrest. Impaired left ventricular systolic function is reported in nearly two-thirds of patients resuscitated after cardiac arrest. Hypotension and shock requiring vasopressor support are similarly common after cardiac arrest. Whereas shock requiring vasopressor support is consistently associated with an adverse outcome after cardiac arrest, the association between myocardial dysfunction and outcomes is less clear. Myocardial dysfunction and shock after cardiac arrest develop as the result of preexisting cardiac pathology with multiple superimposed insults from resuscitation. The pathophysiology involves cardiovascular ischemia/reperfusion injury and cardiovascular toxicity from excessive levels of inflammatory cytokine activation and catecholamines, among other contributing factors. Similar mechanisms occur in myocardial dysfunction after cardiopulmonary bypass, in sepsis, and in stress-induced cardiomyopathy. Hemodynamic stabilization after resuscitation from cardiac arrest involves restoration of preload, vasopressors to support arterial pressure, and inotropic support if needed to reverse the effects of myocardial dysfunction and improve systemic perfusion. Further research is needed to define the role of postarrest myocardial dysfunction on cardiac arrest outcomes and identify therapeutic strategies.
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A Nasal High-Flow System Prevents Hypoxia in Dental Patients Under Intravenous Sedation. J Oral Maxillofac Surg 2015; 73:1058-64. [DOI: 10.1016/j.joms.2014.12.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/25/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022]
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Veerabhadrappa S, Vyas AL, Anand S, Das N. Monitoring cardiovascular changes due to local anesthesia during and after tooth extraction using pulse wave analysis. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2014.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yokoe C, Hanamoto H, Sugimura M, Morimoto Y, Kudo C, Niwa H. A prospective, randomized controlled trial of conscious sedation using propofol combined with inhaled nitrous oxide for dental treatment. J Oral Maxillofac Surg 2014; 73:402-9. [PMID: 25530275 DOI: 10.1016/j.joms.2014.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/30/2014] [Accepted: 09/18/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Adverse reactions during propofol sedation include a decrease in arterial blood pressure, propofol-induced pain on injection, and airway complications. The purpose of this study was to investigate whether combined use of intravenous propofol and inhaled nitrous oxide could decrease the hypotensive and other adverse effects of propofol. PATIENTS AND METHODS We designed and implemented a prospective, randomized controlled trial. Patients undergoing dental procedures requiring intravenous sedation were randomly allocated to 2 groups: group P comprised those receiving sedation with propofol alone, and group N+P comprised those receiving sedation with 40% nitrous oxide inhalation and propofol. During the dental procedures, the sedation level was maintained at an Observer's Assessment of Alertness/Sedation scale score of 4 by adjusting propofol's target plasma concentration. Nitrous oxide inhalation was the predictor variable, whereas the hemodynamic changes, amount and concentration of propofol, and adverse events were the outcome variables. RESULTS Eighty-eight patients were successfully analyzed without any complications. The total amount of propofol was significantly less in group N+P (249.8 ± 121.7 mg) than in group P (310.3 ± 122.4 mg) (P = .022), and the mean concentration of propofol was significantly less in group N+P (1.81 ± 0.34 μg/mL) than in group P (2.05 ± 0.44 μg/mL) (P = .006). The mean blood pressure reduction in group N+P (11.0 ± 8.0 mm Hg) was significantly smaller than that in group P (15.8 ± 10.2 mm Hg) (P = .034). Pain associated with the propofol injection and memory of the procedure were less in group N+P (P = .011 and P = .048, respectively). Nitrous oxide did not affect respiratory conditions or recovery characteristics. CONCLUSIONS The results of this study suggest that nitrous oxide inhalation combined with propofol sedation attenuates the hypotensive effect and pain associated with propofol injections, along with potentiating the amnesic effect.
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Affiliation(s)
- Chizuko Yokoe
- Resident, Department of Dental Anesthesiology, Dr Yokoe is now Resident with the Department of Anesthesia, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Hiroshi Hanamoto
- Assistant Professor, Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan.
| | - Mitsutaka Sugimura
- Associate Professor, Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Yoshinari Morimoto
- Associate Professor, Department of Dental Anesthesiology, Dr Morimoto is now Associate Professor with the Special Patient Oral Care Unit, Kyushu University Hospital, Fukuoka, Japan
| | - Chiho Kudo
- Associate Professor, Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Hitoshi Niwa
- Professor, Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan
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The effect of nitrous oxide inhalation on the hypotensive response to propofol: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:166-73. [PMID: 23743209 DOI: 10.1016/j.oooo.2013.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/11/2013] [Accepted: 03/27/2013] [Indexed: 01/02/2023]
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Kawaai H, Tomita S, Nakaike Y, Ganzberg S, Yamazaki S. Intravenous Sedation for Implant Surgery: Midazolam, Butorphanol, and Dexmedetomidine Versus Midazolam, Butorphanol, and Propofol. J ORAL IMPLANTOL 2014; 40:94-102. [DOI: 10.1563/aaid-joi-d-11-00200] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We compared the amnesic action, recovery process, and satisfaction of patients and surgeons after the use of 2 different sedation regimens for 40 patients undergoing scheduled implant surgery. Butorphanol, midazolam, dexmedetomidine (BMD) was administered to 20 patients who were maintained with continuous infusion of dexmedetomidine after the induction with butorphanol and midazolam, and butorphanol, midazolam, propofol (BMP) was administered to 20 patients who were maintained with continuous infusion of propofol after the induction with butorphanol and midazolam. To assess the amnesic action, the memory of local anesthesia, auditory memory, and visual memory were evaluated. The Trieger Dot Test (TDT) was applied during the recovery process. A questionnaire regarding the patient's feelings of the management of sedation was taken from each patient and was also filled out by the surgeon. The comparison between groups was analyzed by the Mann-Whitney U test. No significant differences in the amnesic action and the TDT were noted. Both methods also satisfied the patients and surgeons, as determined by the questionnaire results. In conclusion, both sedation regimens are appropriate for implant surgery.
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Affiliation(s)
- Hiroyoshi Kawaai
- Department of Dental Anesthesiology, Ohu University School of Dentistry, Fukushima, Japan
| | - Shu Tomita
- Department of Dental Anesthesiology, Ohu University School of Dentistry, Fukushima, Japan
| | - Yoshihiro Nakaike
- Department of Dental Anesthesiology, Ohu University School of Dentistry, Fukushima, Japan
| | - Steven Ganzberg
- Department of Anesthesiology, Ohio State University College of Dentistry, Columbus, Ohio
| | - Shinya Yamazaki
- Department of Dental Anesthesiology, Ohu University School of Dentistry, Fukushima, Japan
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Santana MDR, de Souza ACA, de Abreu LC, Valenti VE. Association between oral variables and heart rate variability. Int Arch Med 2013; 6:49. [PMID: 24373329 PMCID: PMC3879647 DOI: 10.1186/1755-7682-6-49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022] Open
Abstract
The heart rate variability is a useful method to assess cardiac autonomic modulation in patients undergoing dental procedures, because knowledge of physiological conditions provides greater security to the professional as well as the possibility of a better plan treatment to patient benefit. The aim of our study was to describe the association between cardiac autonomic control and dental variables. We consulted the databases Medline, SciELO, Lilacs and Cochrane, using the terms “autonomic”, “dentistry”, “heart rate variability”, “cardiovascular physiology.” The selected studies indicated a strong relationship between dental variables and HRV. There was an association between malocclusion, TMD, dental procedures cirugia and low HRV. Thus, they become more studies that relate to HRV in dental science, especially in clinical practice.
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Affiliation(s)
- Milana Drumond Ramos Santana
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av, Príncipe de Gales, 821, Santo André, SP 09060-650, Brazil.
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Cough Reflex Under Intravenous Sedation During Dental Implant Surgery Is More Frequent During Procedures in the Maxillary Anterior Region. J Oral Maxillofac Surg 2013; 71:e158-63. [DOI: 10.1016/j.joms.2012.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/21/2012] [Accepted: 12/14/2012] [Indexed: 11/22/2022]
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Inhalational conscious sedation with nitrous oxide enhances the cardiac parasympathetic component of heart rate variability. ACTA ACUST UNITED AC 2008; 106:e1-5. [DOI: 10.1016/j.tripleo.2008.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 07/31/2008] [Accepted: 08/27/2008] [Indexed: 11/19/2022]
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:388-94. [PMID: 17620851 DOI: 10.1097/aco.0b013e3282c3a878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Dentistry treatment is one of the most anxiety-inducing events in people's lives. The development of pain and anxiety-control techniques has always been very closely aligned to the development of dentistry. The purpose of this review is to summarize the recent literature in this field. RECENT FINDINGS The literature in the last 12 months falls into four main categories: dental anxiety and its influence on patient care, dental sedation for children, sedation with benzodiazepines for dentistry, and intravenous propofol sedation for dentistry. SUMMARY Considerable progress is being made with a number of innovative techniques. Oral midazolam for children and patient-controlled propofol show very promising results. More research is needed before propofol can be recommended for use without anaesthetic staff. The recently published systematic review of sedation in children outlines gaps in the literature and contains recommendations for future work.
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Affiliation(s)
- Jason Leitch
- Oral Surgery/Sedation, Glasgow Dental Hospital and School, Scotland bSpecial Care & Sedation Department, Lothian Salaried Primary Care Dental Service, Edinburgh, Scotland, UK.
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