J Korean Assoc Oral Maxillofac Surg 2017; 43(4): 229~238
Risk factor analysis of additional administration of sedative agent and patient dissatisfaction in intravenous conscious sedation using midazolam for third molar extraction
Dong-Whan Shin1, Jin-Yong Cho2, Yoon-Sic Han3, Hye-Young Sim4, Hee-Sun Kim4, Da-Un Jung4, Ho Lee3
1Department of Oral and Maxillofacial Surgery, Dankook University Jukjeon Dental Hospital, Yongin,
2Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon,
3Department of Oral and Maxillofacial Surgery, Section of Dentistry, SMG-SNU Boramae Medical Center,
4Section of Dentistry, SMG-SNU Boramae Medical Center, Seoul, Korea
Ho Lee
Department of Oral and Maxillofacial Surgery, Section of Dentistry, SMGSNU Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea
TEL: +82-2-870-2496 FAX: +82-2-831-0714 E-mail: neo0224@gmail.com ORCID: http://orcid.org/0000-0002-0413-2954
Received March 24, 2017; Revised May 10, 2017; Accepted May 26, 2017.; Published online August 31, 2017.
© Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives: The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction.
Materials and Methods: Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer’s assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05.
Results: Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction.
Conclusion: The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.
Keywords: Midazolam, Conscious sedation, Drug dosage calculation, Patient satisfaction, Third molar

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31 December 2017
Vol. 43
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