Prospective audit: anterograde amnesic effects of IV sedation with midazolam in patients having oral surgery procedures

Abstract

##Statement of the problem Concerns were expressed over the level of sedation patients were receiving for oral surgery procedures, with many patients claiming to have had a recollection of the procedure despite receiving IV sedation. ##Purpose of study To determine if patients who are undergoing IV sedation with midazolam in the Oral Surgery Department in the Dublin Dental University Hospital (DDUH) and at the National Centre for Coagulation Disorders are being adequately sedated. ##Material and methods IV midazolam was administered by the sedationists incrementally. Data was collected through specific questionnaires at two different stages. These assessed patients’ objective and subjective recollection of events following their procedure under IV sedation. The patients were asked specific questions immediately postoperatively and subsequently at their review appointment. This assessed the patients’ objective and subjective recall of the procedure under IV sedation. ##Result Immediately postoperatively, 23% of patients had no recollection of the procedure, 55% had only partial recollection of the procedure, while 22% of patients recalled the procedure. One week postoperatively, total amnesia increased to 32%, partial amnesia reduced to 46%, while those recalling the procedure remained the same at 22%. While 78% of patients had some degree of amnesia of the procedure there were 22% who did not have amnesic effects from the sedative. ##Conclusions There is large inter-individual variation in response to IV sedation with midazolam regarding the anterograde amnesic effects. The reason why a certain proportion of patients have full recollection of the procedure needs to be fully investigated, and any confounding factors identified. Improving anterograde amnesia will provide us with the ability to ensure patient comfort, which is crucial to improving patient care.