The influence of oral VPA on the required dose of propofol for sedation during dental treatment in patients with mental retardation: A prospective observer-blinded cohort study
The influence of oral VPA on the required dose of propofol for sedation during dental treatment in patients with mental retardation: A prospective observer-blinded cohort study
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DOI：
10.1111/j.1528-1167.2011.03328.x
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发表时间：
2012-01-01
期刊：
影响因子：
5.6
通讯作者：
Miyawaki, Takuya
中科院分区：
文献类型：
--
作者：
Ishii, Minako;Higuchi, Hitoshi;Miyawaki, Takuya
在中、重度精神发育迟滞牙科患者的镇静中，很难确定最佳镇静水平并适当地维持它。此外，许多患者伴有癫痫，并服用口服抗癫痫药物，这会影响药物代谢酶。特别是丙戊酸(VPA)在体外可以抑制异丙酚的代谢。因此，本研究的目的是采用前瞻性队列研究设计，研究口服丙泊酚对镇静所需异丙酚剂量的临床影响。我们研究了45名中、重度精神发育迟滞患者，他们在镇静状态下接受牙科治疗。输注异丙酚，并使用脑电双频指数(BIS)监测仪将所有患者的镇静维持在相同水平。在预定的患者治疗结束后，将患者分为口服VPA治疗组(VPA组：20例)和不服用任何口服抗癫痫药物的患者(对照组：25例)。评估镇静所需的异丙酚剂量以及睫毛反射和自发睁眼的恢复时间。VPA组和对照组丙泊酚用量中位数分别为4.15(1.975.88)和5.67(2.927.17)mg/kg/h。我们观察到两组患者的VPA中位数剂量有统计学意义的差异(p<；0.01)。然而，在睫毛反射恢复或自发睁眼的时间上，两组之间没有统计学上的显著差异。结果表明，口服丙泊酚可减少中度或重度精神发育迟滞患者在牙科治疗期间所需的异丙酚镇静剂量。
In sedation of dental patients with moderate or severe mental retardation, it is difficult to identify the optimum sedation level and to maintain it appropriately. Moreover, many patients have concomitant epilepsy and are medicated with oral antiepileptic drugs (AEDs), which influence the drug-metabolizing enzymes. In particular, valproate (VPA) has been demonstrated to inhibit propofol metabolism in vitro. Therefore, the objective of the present study was to investigate the clinical influence of oral VPA on the required dose of propofol for sedation, with use of a prospective cohort study design. We studied 45 patients with moderate or severe mental retardation who underwent dental treatment under sedation. Propofol was infused, and sedation was maintained at the same level in all patients using a bispectral index (BIS) monitor. After the completion of treatment for the scheduled patients, patients were divided into those with oral VPA treatment (VPA group: 20 patients) and without any oral antiepileptic treatment (control group: 25 patients). The propofol dose required for sedation and times to the recovery of the eyelash reflex and spontaneous eye opening were evaluated. The median required propofol doses in the VPA and control groups were 4.15 (range 1.975.88) and 5.67 (2.927.17) mg/kg/h, respectively. We observed a statistically significant difference between the two patient groups with respect to median VPA dose (p < 0.01). However, no statistically significant differences were noted in the time until eyelash reflex recovery or spontaneous eye opening between the two groups. The results suggest that oral VPA reduces the dose of propofol required for sedation during dental treatment in patients with moderate or severe mental retardation.