J Korean Assoc Oral Maxillofac Surg.  2022 Dec;48(6):348-355. 10.5125/jkaoms.2022.48.6.348.

Comparison of vital sign stability and cost effectiveness between midazolam and dexmedetomidine during third molar extraction under intravenous sedation

• Kim JY
• Park SY
• Han YS
• Lee H

• KMID: 2537560
• DOI: http://doi.org/10.5125/jkaoms.2022.48.6.348

Abstract

Objectives
To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX).
Patients and Methods
This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pres-sure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer’s assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05.
Results
The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had simi- lar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000).
Conclusion
DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.

Keyword

Conscious sedation; Third molar; Tooth extraction; Midazolam; Dexmedetomidine

Figure

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  Fig. 1 Comparison of vital signs between the two treatment groups during the course of surgery in each period. A. Comparison of heart rate (HR): After sedative administration, HR increased in both groups, but it showed a higher value in the midazolam (MDZ) group than the dexmedetomidine (DEX) group in all periods. B. Comparison of systolic noninvasive blood pressure (SBP): After sedative administration, SBP increased in the MDZ group and decreased in the DEX group, showing a higher value in the MDZ group 20 minutes after local anesthesia and thereafter. C. Comparison of diastolic noninvasive blood pressure (DBP): After sedative administration, DBP decreased in both groups, showing a higher value in the DEX group 5 minutes after sedative administration and in the MDZ group at the beginning of the primary closure. *P<0.05 by Student’s t-test. (T0: the moment right before sedative administration, T1: 5 minutes after sedative administration, T2: the time of injection of the local anesthetic agent, T3: 20 minutes after local anesthesia, T4: the time of the start of the primary closure)

• 

  Fig. 2 Comparison of the bispectral index score (BIS) between the two treatment groups during the course of surgery in each period. *P<0.05 by Student’s t-test. (T0: the moment right before sedative administration, T1: 5 minutes after sedative administration, T2: the time of injection of the local anesthetic agent, T3: 20 minutes after local anesthesia, T4: the time of the start of the primary closure, MDZ: midazolam, DEX: dexmedetomidine)

Reference

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