Effects of antipsychotics on intravenous sedation with midazolam and propofol during dental treatment for patients with intellectual disabilities
Effects of antipsychotics on intravenous sedation with midazolam and propofol during dental treatment for patients with intellectual disabilities
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DOI：
10.1111/jir.12913
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发表时间：
2022-01-17
影响因子：
3.6
通讯作者：
Okada, Y.
中科院分区：
文献类型：
--
作者：
Oda, Y.;Yoshida, K.;Okada, Y.
背景 一些智力障碍 (ID) 患者需要服用抗精神病药物来对症治疗行为障碍。尽管如此，对于一些智力障碍患者来说，安全地进行牙科治疗仍然很困难。在这种情况下，静脉镇静（IVS）治疗是一种选择。抗精神病药物的镇静、催眠和α-受体阻滞作用可能会导致定期服用抗精神病药物的患者发生严重低血压等不良事件。本研究旨在探讨 IVS 期间口服抗精神病药物对心血管功能的影响。因此，我们比较了定期服用抗精神病药物和不服用抗精神病药物的患者的平均血压（MBP）和心率（HR）。方法 37 例智力障碍患者纳入本研究。所有参与者均为总医院特护牙科门诊患者，并接受咪达唑仑和异丙酚联合IVS下的牙科治疗。 18 名患者定期服用抗精神病药物（药物组），19 名患者目前未服用抗精神病药物（非药物组）。在三个点测量 MBP、HR、剂量和静脉镇静药物的效应部位浓度：“IVS 之前”、“最佳镇静状态”和“牙科治疗期间”。结果 药物组MBP降低幅度明显小于非药物组（P < 0.023）。然而，在任何时间点，各组之间的 MBP、HR、剂量以及咪达唑仑和异丙酚的效应部位浓度均没有差异。结论 这些结果表明，在 IVS 牙科治疗期间，抗精神病药物可能不会对智力障碍患者的心血管波动产生临床上显着的不良影响。
Background Some patients with intellectual disabilities (ID) are prescribed antipsychotic drugs for symptomatic treatment of behavioural disorders. Nevertheless, it can still prove difficult to perform dental treatments safely for some patients with ID. In such cases, treatment under intravenous sedation (IVS) is one option. Sedative, hypnotic and alpha-blocking effects of antipsychotic drugs may cause adverse events, such as severe hypotension, among patients who take antipsychotic drugs regularly. This study aimed to investigate the effects of oral antipsychotic medication on cardiovascular function during IVS. Accordingly, we compared mean blood pressure (MBP) and heart rate (HR) between patients who regularly take antipsychotic drugs and patients who do not. Methods Thirty-seven patients with ID were enrolled in this study. All participants were outpatients of Special Care Dentistry of general hospital and received dental treatment under IVS performed with a combination of midazolam and propofol. Eighteen patients regularly took antipsychotics (medication group), and 19 patients were not currently taking antipsychotics (non-medication group). MBP, HR, dose, and effect-site concentration of intravenous sedative medications were measured at three points: 'before IVS', 'at optimal sedation', and 'during dental treatment'. Results The magnitude of reduction of MBP was significantly smaller in the medication group than in the non-medication group (P < 0.023). However, there were no differences in MBP, HR, dose, and effect-site concentration of midazolam and propofol between groups at any point. Conclusion These results suggest that antipsychotic medication may not have clinically significant adverse effects on cardiovascular fluctuations during dental treatment under IVS for persons with ID.