Conscious Sedation in Moderated to Advanced Alzheimer’s Disease Old Adults

Objectives: Background: Moderated to advanced Alzheimer’s disease patients showed technical obstacles to complete oral health care: loss of cognitive and motor skills, loss of autonomy, physiological modifications, impaired adaptation processes, and lack of compliance. Conscious sedation had been an alternative technique used to avoid the general anesthesia.
Objective: To determine acceptance, safety and efficacy of the combination oral midazolam and nitrous oxide and oxygen (N₂O/O₂) for conscious sedation in patients with Alzheimer’s disease undergoing dental care.
Methods: Methods: This case report study was developed in dentate elderly with Alzheimer’s disease, stages 6 to 7 (Reisberg’s scale), ASA IV, showing no respiratory disease and controlled cardiovascular conditions, living in a Brazilian long-stay institution. Oral midazolam (7.5 mg) was used one hour before for the acceptance of the mask use. N₂O/O₂ was titration in 40 to 60%. The sedation level was measured by the Ramsay scale. A pulse oximeter was used to monitor vital signs. Arterial oxygen saturation, respiration rate, sedation and behavioral scores were recorded every minute.
Results: Results: A total of 35 patients, 16 males and 19 females, mean age 72 years, were included. The heart and respiratory mean rates for both gender were similar and within acceptable limits. The lowest mean arterial oxygen saturation level was 94%, ranging 94 to 98%, within safe limits. The level of sedation ranged of 2 to 5. Local anesthesia and extractions were 90% of the treatments. Of the 75 sessions, 92% were performed with total acceptance and 6% with doubtful acceptance. In 2%, no treatment could be performed. No complications were registered during or after treatment.
Conclusions: Conclusions: The combination of oral midazolam premedication and nitrous oxide sedation is a safe and effective method of sedation for dental care in moderated to advanced Alzheimer’s disease old adults.