The influence of antiepileptic drugs on intravenous sedation with midazolam and propofol for dental treatments in patients with intellectual disabilities

We studied the influence of antiepileptic drugs on the dosage requirements for intravenous sedation in dental patients with intellectual disabilities. From January 2000 to December 2004, we studied patients with intellectual disabilities between the ages of 18 and 39 who underwent dental treatment with intravenous sedation at the Special Care Unit for Patients with Disabilities at Okayama University Dental Hospital (Present: Okayama University Hospital). Anesthetic records of the first sedation were reviewed. Intravenous sedation was induced with a bolus intravenous administration of midazolam (2-3 mg) and maintained with a continuous infusion of propofol. We divided the patients into two groups: the patients taking antiepileptic drugs (medication group) and not taking them (no-medication group). We investigated the backgrounds of the patients, antiepileptic drugs, ratio of gender, age, weight, anesthesia time, wake-up time, doses of midazolam and propofol in the groups. Data in the groups were compared using a Chi-square test or Unpaired t test. The medication group and the no-medication group had 35 patients and 20 patients, respectively. In the medication group, all patients had epilepsy, 5 patients had cerebral palsy and 6 patients had autism. In the no-medication group, the patients did not have epilepsy or cerebral palsy, and there were 3 patients with autism and 2 patients with Down's syndrome (Table 1). The patients in the medication group had taken 8 kinds of antiepileptic drugs (Table 2). There were no significant differences in sex ratio, age, weight, anesthesia time, dose of midazolam, or wake-up time between the groups (Table 3). The infusion doses of propofol in the medication group and the no-medication group were 4.88±1.15 mg/kg/hr and 5.70±1.69 mg/kg/hr, respectively. Dose of propofol in the medication group was significantly lower than that in the no-medication group (Fig. 1). The present study indicates that lower dose of propofol would be enough for the first sedation for the patients who take antiepileptic drugs compared to the patients who do not take them.