Effects of Implant Surgery on Blood Pressure and Heart Rate During Sedation with Propofol and Midazolam

Purpose: Intravenous (IV) sedation is commonly used in dentistry. However, no report has yet been published regarding age, hypertension, and antihypertensive drugs during implant surgery and their relationship with changes in blood pressure (BP) and heart rate in implant surgery under IV sedation with propofol and midazolam. Materials and Methods: Medical records of 252 patients who underwent implant surgery were retrospectively analyzed. Patients were classified into four groups according to their age (in years) and hypertension status: A = = 64, no hypertension; B = >= 65, no hypertension; C = = 64, hypertension; or D = >= 65, hypertension. Hypertensive patients were further characterized by their antihypertensive medications: E = calcium channel blockers (CCBs), F = angiotensin II receptor blockers (ARBs), G = CCBs+ARBs, or H = no medication. IV sedation was administered in two stages. After midazolam injection to prevent angialgia, propofol was infused at the rate of 4 mg/kg/h, followed by a dose reduction. Systolic and diastolic BP and heart rate were recorded before, during, and after surgery. Results: Systolic BP increased significantly after patients were draped in groups A, C, and D, with group D showing the most pronounced increase. Sedatives decreased BP in all groups. Diastolic BP in group F decreased significantly compared to group H after induction and before infiltration of local anesthetic. After infiltration, systolic BP decreased more significantly in group G than in group H. Intraoperative hypotension was observed in 25% of patients. The incidence of intraoperative hypertension in group D was markedly higher than in group A (23% vs 4%). Conclusion: IV sedation using midazolam and propofol reduces hypertensive risks during implant surgery. Nevertheless, care must be taken, especially in older hypertensive patients and in hypertensive patients on ARBs or ARBs+CCBs. Keywords: angiotensin II receptor blockers, dental implant, hemodynamics, midazolam, moderate sedation, oral surgery propofol