A Study of Recovery from Intravenous Sedation for Dental Treatment in the Elderly

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The recovery of elderly patients from sedation and the time they were able to leave the hospital after injection were compared with those of young and middle-aged adults. To carry out this study, groups of 15 patients in each age group underwent dental treatment after single intravenous bolus sedation with midazolam.The parameters used to determine recovery were arterial saturation of oxygen (SpO2), force of hand grip, spirogram, addition test, and balance test. Parameters were examined as changes in volume, taking the control value (before dental treatment) as zero, and the changes in volume of the two groups were also compared.Midazolam was administered little by little until the optimal sedation level was obtained with no other incremental dose. The midazolam dose required for the elderly group was 60% of that needed for the young and middle-aged group. There were already significant differences between all control values of the two groups except for vital capacity and the balance t … More est with eyes open.In the elderly group, delay of recovery from sedation was seen for SpO2, hand grip, vital capacity, and the balance test using a feedback system via which patients could adjust their center of gravity by watching a trace on a display monitor. There were no significant differences in recovery between the groups for FEV1.0, the addition test and the balance test with eyes open and eyes closed.These results suggest that the elderly should be managed carefully, paying special attention to the decrease in respiratory muscle force under intravenous sedation. Some elderly patients swayed markedly when they tried to adjust their center of gravity slightly when watching the display monitor. This suggested that, in the elderly, the ability to adjust posture during movement rather than the ability to maintain posture decreases. However, even elderly patients could return home 2 hours after administration of midazolam when the optimal amount of the sedative was carefully administered, just like the young and middle-aged adults.The efficacy of and time of recovery from treatment with propofol, which has begun to be used recently for intravenous sedation during oral surgery and dental procedures, were also ascertained for elderly patients. The results suggested that propofol is a useful sedative for such procedures, especially for patients who have developed tolerance against benzodiazepine drugs as a result of long-term use, if the sedation is carried out under careful observation. Less