Determination of the cilinical efficacy and safety of patient-controlled remifentanil application in addition to intravenous midazolam sedation in lover third molar

ABSTRACT Determination of the Clinical Efficacy and Safety of Patient-Controlled Remifentanil Application in Addition to Intravenous Midazolam Sedation in Lower Third Molar Surgery During the surgical removal of impacted third molars, additional pain control and sedation may be required. The purpqse of this study was to evaluate clinical efficacy and safety of patient controlled remifentanil application in addition to intravenous midazolam sedation during third molar surgery. A double-blind, randomized, cross-over, placebo-controlled, prospective clinical study was designed. 20 healthy patients with symmetrically placed impacted bilateral mandibular third molars were included. 0,05 mg/kg intravenous midazolam sedation was applied to each patient in both operations. Patient controlled intravenous remifentanil application was used randomly either in the first operation or in the second one. Patients were given a placebo instead of remifentanil in the other operation. Preoperative, intraoperative and postoperative blood samples were taken in both operations in order to determine the changes in the stress hormone (aldosterone, renin, ACTH) levels in blood. Blood pressure, heart rate, oxygen saturation and respiration rate were recorded before sedation, every five minutes during surgery and five minutes after surgery. Ramsey's sedation scale was used to evaluate the level of sedation and modified Steward's recovery scale was used to score the patients recovery level at the end of the operation. Pain, patient satisfaction, cooperation score, reaction to local anesthetic injection and degree of amnesia were also assessed. There were no significant differences in the durations of surgery between the two groups. Remifentanil significantly increased the level of sedation, patient cooperation and satisfaction; decreased the oxygen saturation, heart rate and pain. There was a mild increase in amnesia in the remifentanil group. There was significant change in renin levels between the two groups and no statistically significant difference in aldosterone and ACTH levels. Aldosterone and ACTH levels were significantly decreased, whereas renin level was significantly increased during both of the operations. Remifentanil did not significantly effect the recovery time. Patient controlled remifentanil application in addition to IV midazolam sedation seems to provide efficient pain control and sufficient sedation without any important side effect. Keywords : IV sedation, Midazolam, Patient-controlled analgesia, Remifentanil, Third molar surgery xu