Abstract
Introduction
Intravenous sedation is performed to ensure smooth and safe surgery. Dental anxiety is a reaction to an unknown danger. The Spielberger's state-trait anxiety inventory (STAI) can be used to simultaneously evaluate the levels of state and trait anxiety. State anxiety is defined as subjective feelings of nervousness. This study assessed the presurgical anxiety using STAI and performed intravenous sedation for patients whose level of state anxiety was > stage IV. Based on our clinical experience, it is believed that higher doses of sedatives are needed to induce the desired levels of sedation in patients with a high level of state anxiety.
Objectives
This study examined whether the sedative consumption of the patient with a high anxiety level increased.
Patients and Methods
Patients with state anxiety scores of ≥51 were included in Group V, and those with state anxiety scores ranging from 42 to 50 were placed in Group IV. To induce sedation, intravenous access was established, and a bolus dose of 3.0 mg midazolam was administered intravenously. Sedation was maintained by administering a continuous infusion of propofol, which was aimed at achieving an Observer's Assessment of Alertness/Sedation scale of 10–12/20. In this study, midazolam was initially administered when the body movements appeared to occur or the blood pressure increased. This was followed by the administration of higher doses of propofol if low sedation was observed.
Results
There were no significant differences in the patient demographics, duration of sedation, and doses of local anaesthetic agents between Groups IV and V. The midazolam dose and mean propofol dose needed to maintain comparable levels of sedation were significantly higher in Group V than in Group IV.
References
1. Spielberger CD, Gorusch RL, Lushene RE. Mannual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologist's Press;1970.
2. Dionne RA, Yagiela JA, Cote ′CJ, Donaldson M, Edwards M, Greenblatt DJ, et al. Balancing efficacy and safty in the use of oral sedation in dental outpatients. J Am Dent Assoc. 2006; 137:502–13.
3. Boker A, Brownell L, Donen N. The amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety. Can J Anaesth. 2002; 49:792–8.
4. Weinstein P, Shimono T, Domoto P, Wohlers K, Matsumura S, Ohmura M, et al. Dental fear in japan: Okayama prefecture school study of adolescents and adults. Anesth Prog. 1992; 39:215–20.
5. Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam preoperative anxiety and information scale(APAIS). Anesth Analg. 1996; 82:445–51.
6. Kim WS, Byeon GJ, Song BJ, Lee HJ. Availability of preoperative anxiety scale as a predictive factor for hemodynamic changes during induction of anesthesia. Korean J Anesthesiol. 2010; 58:328–33.
7. Osborn TM, Sandler NA. The effects of preoperative anxiety on intravenous sedation. Anesth Prog. 2004; 51:46–51.