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Clinical considerations in providing intravenous sedation with midazolam for obese patients in dentistry

British Dental Journal volume 230, pages 587–593 (2021)Cite this article

Abstract

The widespread prevalence of obesity continues to rise. Obesity and dental disease share common risk factors and so the demand for dental care for obese patients is escalating. For some of these patients, there is a corresponding need to be able to provide intravenous sedation safely when it is necessary and appropriate to do so. However, obesity often presents with multiple comorbidities and airway complexities, leading to more challenging management and potentially increased risk. The risk assessment process as well as patient monitoring and management strategies will be explored in this article. By reviewing the literature from dentistry and other medical specialties, we also aim to establish the potential benefit in administering supplemental oxygen and the use of capnography in monitoring this cohort of patients.

Key points

  • The provision of intravenous sedation for obese patients is associated with potentially increased risk due to the associated medical comorbidities and various anatomical factors.

  • Thorough risk assessment will reduce the possibility of adverse events during the provision of sedation for obese patients.

  • Use of supplemental oxygen and capnographic monitoring should be considered when providing sedation for obese patients.

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Authors and Affiliations

  1. Specialty Registrar in Special Care Dentistry, Birmingham Community Healthcare NHS Foundation Trust, Dental Department, Floor 3, Attwood Green Health Centre, 30 Bath Row, Birmingham, B15 1LZ, UK

    Gillian C. Howie

  2. Consultant in Special Care Dentistry and Head of Special Care Dentistry, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK

    Nicholas Ransford

  3. Consultant Anaesthetist, Liver Specialists Lead, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Scott H. Russell

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  1. Gillian C. Howie
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Correspondence to Gillian C. Howie.

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Howie, G., Ransford, N. & Russell, S. Clinical considerations in providing intravenous sedation with midazolam for obese patients in dentistry. Br Dent J 230, 587–593 (2021). https://doi.org/10.1038/s41415-021-2944-9

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