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Cross-sectional study of propofol dose during intravenous sedation for dental surgery in patients with long-term oral benzodiazepine therapy : A secondary publication

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Title: Cross-sectional study of propofol dose during intravenous sedation for dental surgery in patients with long-term oral benzodiazepine therapy : A secondary publication
Authors: Fujisawa, Toshiaki Browse this author →KAKEN DB
Miyata, Kazuki Browse this author
Nitta, Yukie Browse this author →KAKEN DB
Terui, Akifumi Browse this author
Ishikawa, Emi Browse this author
Hamaya, Eri Browse this author
Wakana, Keiichiro Browse this author
Takuma, Shigeru Browse this author →KAKEN DB
Shibuya, Makiko Browse this author →KAKEN DB
Keywords: benzodiazepines
conscious sedation
drug interactions
propotol
Issue Date: 19-Jun-2022
Publisher: John Wiley & Sons
Journal Title: Clinical and Experimental Dental Research
Publisher DOI: 10.1002/cre2.601
PMID: 35719036
Abstract: Objectives: The amount of propofol required for intravenous sedation (IVS) in patients on long-term oral benzodiazepine (BZD) therapy may be affected by drug interactions and central changes in sensitivity. However, there is no research on the effect of long-term oral BZD use on the amount of propofol required for IVS. We aimed to clarify the difference between the total propofol dose required for IVS in patients with or without long-term oral BZD therapy. Material and methods: Among patients treated for 4 years, the total administered dose required for IVS with propofol alone and local anesthesia for the extraction of bilateral impacted mandibular wisdom teeth, was retrospectively compared between patients with continuous oral BZD use for >= 6. months (BZD group; n = 24) and those without such use (control group; n = 307). The aimed sedation level was the Ramsay sedation scale 3-4. Results: The amount of propofol required for IVS was significantly lower in the BZD group compared to the control group (4.83 +/- 1.30 vs. 5.91 +/- 1.25 mg/kg/h, p < .001; 95% confidence interval, -1.22 to -0.94 mg/kg/h; Cohen's d, 0.84). The required propofol dose was not influenced by preoperative oral BZD administration on the day of extraction (presence [n = 13] vs. absence [n =11]: 4.9 +/- 1.3 vs. 4.8 +/- 1.7 mg/kg/h, p = .83). Long-term oral BZD therapy remained a significant factor for a lower required propofol dose after adjusting for age with multiple linear regression analysis. The underlying mechanism cannot be an additive action process but might pertain to competitive inhibition via an enzyme involved in glucuronate conjugation or competitive albumin binding. Conclusions: Clinicians should understand that patients on long-term oral BZDs therapy might require less propofol for IVS than those not on BZDs, irrespective of whether BZDs were taken preoperatively on the day of surgery.
Type: article
URI: http://hdl.handle.net/2115/86515
Appears in Collections:歯学院・歯学研究院 (Graduate School of Dental Medicine / Faculty of Dental Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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