Predictors of Hypoxemia During Moderate Sedation for Periodontal Surgeries: A Series of 2221 Sedations

Abstract

OBJECTIVES

The objectives of this investigation are to determine the incidence of hypoxemia during moderate sedation for periodontal and implant surgery and identify statistically significant predictors of hypoxemia.

METHODS

Records of patients receiving moderate sedation for periodontal or dental implant surgery were assessed for hypoxemic events, defined as SpO2 ≤ 90%. A binomial logistic regression analysis was completed to assess the influence of patient-, sedation-, and procedure-related variables on hypoxemia occurrence.

RESULTS

Records of 2221 sedations were available for analysis. At least one hypoxemic event occurred in 117 (5.3%) sedations. Only 22 (1.0%) sedations involved more than one event. Age (OR: 1.022; 95%CI: 1.004 – 1.039; p = .02) and total midazolam dose (OR: 1.118; 95%CI: 1.024 – 1.22; p = .01) were statistically significant predictors of hypoxemia. The association between body mass index and hypoxemia did not reach statistical significance (OR: 1.042; 95%CI: .995 – 1.091; p = .08

CONCLUSIONS

In the 2221 evaluated procedures, no adverse effects were observed, and no reversal medications were administered. As seen in prior research, age and the total dose of midazolam were statistically significant predictors of hypoxemia, though BMI failed to reach statistical significance in the final model. Although additional research is necessary, it is possible that patients receiving moderate sedation for periodontal/implant surgery are less likely to experience hypoxemia due to smaller total doses of sedatives, titration of sedatives over longer procedure durations, and greater need for intraoperative patient cooperation.

IMPLICATIONS

The findings of this study suggest that moderate sedation for periodontal and dental implant surgery is a safe service for patients which may mitigate fear and anxiety, and ultimately enhance the patient experience, and increase access to care.