Вестник анестезиологии и реаниматологии (Jul 2018)
SEDATION IN DENTISTRY AND OUT-PATIENT MAXILLOFACIAL SURGERY. THEORY AND PRACTICE
Abstract
The article describes sedation in dentistry and out-patient maxillofacial surgery. The definitions of sedation, psychoemotional comfort and discomfort are thoroughly described and introduced. A special emphasis is put on pathophysiology of psychoemotional discomfort and peri-operative stress. According to modern data, the objectives to be achieved by an anesthesiologist have been reviewed: provision of psychoemotional inhibition (as a basis of comfort staying in a dental chair), but not depression of consciousness as it used to be before.With much detail it analyzes complication occurring during anesthesia; their correlations with age, concurrent conditions, anesthetic agent and doctor's professional level are highlighted.The article presents a clinical picture of sedation depending on the depression of consciousness, respiration, and hemodynamics (ADA and ASA, 2016). It depicts thoroughly the state of minimal sedation (anxiolysis), moderate sedation (awake sedation), deep sedation and general anesthesia. Special attention is paid to the provision of patient's safety related to supporting airway patency and hemodynamics.The article presents methods of sedation from the position of modern global data and personal experience of authors. Methods of medication administration are mentioned: enteral, parenteral, including intra-nasal which is fairly popular of late.Special attention is paid to specific problems of sedation, presence of motion activity, psychoemotional agitation, compulsive coughing. Potential causes of these events are described, in particular, correlation between psychoemotional agitation with dysregulation of GABA-ergic and dopaminergic systems.Current data on the intra-operative monitoring are presented, as an important component of the patient's safety during sedation. Additionally to Harvard Standard, it is recommended to use capnography and monitoring of sedation depth through bispectral index.
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