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Yang R, Zhao R, Chaudry F, Wang T, Brunton P, Khurshid Z, Ratnayake J. Modern sedative agents and techniques used in dentistry for patients with special needs: A review. J Taibah Univ Med Sci 2024; 19:153-163. [PMID: 38047240 PMCID: PMC10692720 DOI: 10.1016/j.jtumed.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023] Open
Abstract
According to the World Health Organisation, approximately 1.3 billion people worldwide experience substantial disability due to physical, mental or sensory impairment. People with special needs require special consideration and more time or altered delivery methods when receiving dental treatments. Various factors, such as patients' lack of cooperation, cognitive impairment and complex medical status, may lead dental practitioners to recommend conscious sedation. Several pharmacological agents and administrative routes are available, which achieve varying levels of sedation ranging from minimal to deep. Pre-operative assessment and careful case selection are necessary to determine the appropriate sedative agent, route of administration and level of sedation for each patient. Thus, a thorough understanding of the pharmacokinetics, risks and benefits, and implications of various sedatives available for PSN is essential to achieve the desired clinical outcomes. This review critically presents the considerations associated with the use of various sedative agents for PSN in dentistry. Considerations include patients' pre-anaesthesia medical comorbidities, cardiorespiratory adverse effects and cooperativeness, and the viable alternative treatment modalities.
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Affiliation(s)
- Ruijia Yang
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Rusin Zhao
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Fatima Chaudry
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Tao Wang
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Paul Brunton
- Department of Prosthodontics and Dental Implantology, Curtin University, Bentley, Australia
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, KSA
| | - Jithendra Ratnayake
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Butters E, Srinivasan S, O'Brien JT, Su L, Bale G. A promising tool to explore functional impairment in neurodegeneration: A systematic review of near-infrared spectroscopy in dementia. Ageing Res Rev 2023; 90:101992. [PMID: 37356550 DOI: 10.1016/j.arr.2023.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
This systematic review aimed to evaluate previous studies which used near-infrared spectroscopy (NIRS) in dementia given its suitability as a diagnostic and investigative tool in this population. From 800 identified records which used NIRS in dementia and prodromal stages, 88 studies were evaluated which employed a range of tasks testing memory (29), word retrieval (24), motor (8) and visuo-spatial function (4), and which explored the resting state (32). Across these domains, dementia exhibited blunted haemodynamic responses, often localised to frontal regions of interest, and a lack of task-appropriate frontal lateralisation. Prodromal stages, such as mild cognitive impairment, revealed mixed results. Reduced cognitive performance accompanied by either diminished functional responses or hyperactivity was identified, the latter suggesting a compensatory response not present at the dementia stage. Despite clear evidence of alterations in brain oxygenation in dementia and prodromal stages, a consensus as to the nature of these changes is difficult to reach. This is likely partially due to the lack of standardisation in optical techniques and processing methods for the application of NIRS to dementia. Further studies are required exploring more naturalistic settings and a wider range of dementia subtypes.
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Affiliation(s)
- Emilia Butters
- Department of Electrical Engineering, University of Cambridge, 9 JJ Thomson Avenue, Cambridge CB3 0FA, UK; Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Sruthi Srinivasan
- Department of Electrical Engineering, University of Cambridge, 9 JJ Thomson Avenue, Cambridge CB3 0FA, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Neuroscience, University of Sheffield, 385a Glossop Rd, Broomhall, Sheffield S10 2HQ, UK
| | - Gemma Bale
- Department of Physics, University of Cambridge, 19 JJ Thomson Avenue, Cambridge CB3 0FA, UK
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Comparison of intravenous sedation using midazolam versus dexmedetomidine in elderly patients with dementia: a randomized cross-over trial. Sci Rep 2022; 12:6293. [PMID: 35428817 PMCID: PMC9012813 DOI: 10.1038/s41598-022-10167-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/24/2022] [Indexed: 11/22/2022] Open
Abstract
Differences between the effects of intravenous sedation with midazolam (MID) and dexmedetomidine (DEX) on the cerebral function of elderly patients with severe dementia are unclear. This study aimed to compare the effects of intravenous sedation with MID or DEX on parameters such as brain waves and cerebral blood flow (CBF). This cross-over study analyzed 12 patients with severe dementia, with each patient receiving both drug treatments. Each drug was administered until a Modified Observer’s Assessment of Alertness/Sedation (OAA/S) score of 2 was reached. Bispectral index (BIS) and normalized tissue hemoglobin index (nTHI), which reflects CBF using near-infrared spectroscopy, were measured. Mann–Whitney U, Wilcoxon signed-rank, and Friedman tests, and multiple regression analysis were performed. While a similar decline in BIS values was observed in both groups (P < 0.030), there was a significant decrease in nTHI up to 11% in the MID group (P = 0.005). In the DEX group, nTHI values did not differ from baseline. When an OAA/S score of 2 was just achieved, CBF in the MID group (− 5%) was significantly lower than in the DEX group (± 0%). In dementia patients, sedation with MID resulted in a decrease in CBF, while the CBF value was maintained during sedation with DEX.
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Wang HY, Ren L, Li T, Pu L, Huang X, Wang S, Song C, Liang Z. The impact of anxiety on the cognitive function of informal Parkinson's disease caregiver: Evidence from task-based and resting-state fNIRS. Front Psychiatry 2022; 13:960953. [PMID: 36159948 PMCID: PMC9492928 DOI: 10.3389/fpsyt.2022.960953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Informal Parkinson's disease (PD) caregivers are considered to experience high levels of caregiver burden, negatively affecting the health of caregivers. However, few studies explored the relationship between anxiety in caregiver burden and cognitive function in informal PD caregivers. Although, no study has even investigated the neural mechanisms underlying this connection. This study aimed to conduct comprehensive cognitive and clinical assessments and evaluate brain activity from task-based state and resting-state using functional near-infrared spectroscopy (fNIRS). A total of ten informal PD caregivers and 15 matched, healthy, non-caregivers were recruited. Comprehensive cognitive and clinical assessments were conducted to evaluate five cognitive domains and mental states. Neural activity induced by verbal fluency task (VFT) and brain connectivity during resting state were monitored, and their correlations with the neuropsychological and clinical tests were explored. Our results showed that compared to non-caregiver, an informal PD caregiver exhibited no difference in most cognitive domains of function but performed better in attentional function, along with higher levels of anxiety. Decreased activation over prefrontal regions during VFT and hypo-connectivity within the frontoparietal network (FPN) and between default mode network (DMN) and FPN in the resting state were confirmed in this study as a result of the negative effects of anxiety on the brain. Furthermore, Spearman's correlation found that neural activity in FPN during task-based state and resting state was negatively correlated with the severity of anxiety. These findings indicate that despite normal or even better cognitive function, informal PD caregivers have impaired brain function, and this deficit in neural activity was related to anxiety.
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Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lu Ren
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tao Li
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lanlan Pu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaofeng Huang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Song Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chunli Song
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhanhua Liang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Saxen MA. A Review of Current Literature of Interest to the Office-Based Anesthesiologist. Anesth Prog 2022; 69:48-50. [PMID: 36223189 PMCID: PMC9552627 DOI: 10.2344/1878-7177-69.3.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Affiliation(s)
- Mark A. Saxen
- Indiana Office-Based Anesthesia Indiana University School of Dentistry Indianapolis, IN
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