An interesting article titled “Complications of Moderate Sedation Versus Deep Sedation/General Anesthesia for Adolescent Patients Undergoing Third Molar Extraction” appears in the 2016 Journal of Oral and Maxilofacial Surgery written by Gino Inverso and et al. (vol. 74, pp. 474-479). The authors set out to determine if there is any difference in complications occurring after wisdom teeth surgery when patients are given either moderate sedation or deep sedation.
For patients undergoing wisdom teeth surgery they may have some say in what level of sedation they receive and it may also be based on the desires of the surgeon. Specifically the authors examined the complications resulting from moderate sedation versus deep sedation/general anesthesia for adolescent patients undergoing wisdom teeth extraction. They sought to determine if any differences in complication risk exist between the two levels of sedation.
The authors explored a database commissioned by the the American Association of Oral and Maxillofacial
Surgeons (AAOMS) which is known as the Oral and Maxillofacial Surgery Outcomes System (OMSOS). A total of 79 surgeons in 58 sites across the 6 AAOMS districts participated in the data collection. The patients had data entered into the OMSOS from January 2001 to December 2010. The patients included in the present study had to be less than or equal to 21 and had wisdom teeth extracted in an ambulatory setting.
The authors state
“Moderate sedation was defined as a minimally depressed level of consciousness produced by a pharmacologic or nonpharmacologic method, or combination, that retained the patient’s ability to maintain their airway independently and continuously and allowed the patient to respond appropriately to physical stimulation and/or verbal commands. Deep sedation/general anesthesia was defined as an induced state of depressed consciousness produced by a pharmacologic or nonpharmacologic method, or combination, that produced a partial loss of protective reflexes, including an inability to maintain an airway independently and/or to respond purposefully to physical stimulation and/or verbal commands.”
A total of 29,548 patients were included in the study. The patients in the deep sedation/general anesthesia group had a higher preoperative anxiety score than those in the moderate sedation group. Most patients in the moderate sedation group did not receive additional parenteral agents (54.5%), while others received propofol and ketamine (at 30.2 and 17.6%, respectively). In the deep sedation/general anesthesia group, the patients most commonly received propofol, methohexital, and ketamine (at 64.8, 29.9, and 16.5%, respectively).
Patients receiving moderate sedation were less likely to experience a complication from anesthesia than those receiving deep sedation/general anesthesia. The patients in the moderate sedation group had an
anesthesia complication rate of 0.5%. The patients receiving deep sedation/general anesthesia had an anesthesia complication rate of 0.9%. The patients receiving deep sedation/general anesthesia were more likely to experience peripheral vascular injury than were those who received moderate sedation. Even so when compared with moderate sedation, deep sedation/general anesthesia did not pose a significantly increased risk of adverse complications.
The authors feel additional studies should be undertaken in older patients and also point out a few limitations of their study such as not recording the dosage of medications used in patients.