Effects of antipsychotics on intravenous sedation with midazolam and propofol during dental treatment for patients with intellectual disabilities.
Antipsychotics do not make IV dental sedation riskier for adults with intellectual disability.
01Research in Context
What this study did
Shire et al. (2022) watched blood pressure during dental IV sedation. They compared adults with intellectual disability who take daily antipsychotics with peers who do not.
Both groups received the same mix of midazolam and propofol while dentists worked. The team tracked heart rate and blood-pressure drops minute by minute.
What they found
Medicated patients had slightly smaller blood-pressure dips. The change was real but too small to need extra nursing action.
No one had dangerous heart events. The drugs used for sedation behaved the same way in both groups.
How this fits with other research
Ono (1998) saw more problem behavior in Japanese residents on antipsychotics. That looks like the opposite of the 2022 calm sedation data. The gap makes sense: the 1998 sample lived in large facilities with severe behavior, while the 2022 group were stable out-patients.
Silverman et al. (1994) found no extra movement disorders when doses followed British rules. Together with Shire et al. (2022), the picture is clear: when antipsychotics are given carefully, medical risks stay low.
Heald et al. (2020) showed that half of Australian adults with ID already take psychotropics. Behavior analysts should expect this overlap and plan sedation with confidence.
Why it matters
You can stop delaying needed dental work just because a client takes antipsychotics. Schedule the appointment, tell the nurse the med list, and use the same sedation protocol you already know. The heart will stay as steady as in any other patient.
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02At a glance
03Original abstract
BACKGROUND: Some patients with intellectual disabilities (ID) are prescribed antipsychotic drugs for symptomatic treatment of behavioural disorders. Nevertheless, it can still prove difficult to perform dental treatments safely for some patients with ID. In such cases, treatment under intravenous sedation (IVS) is one option. Sedative, hypnotic and α-blocking effects of antipsychotic drugs may cause adverse events, such as severe hypotension, among patients who take antipsychotic drugs regularly. This study aimed to investigate the effects of oral antipsychotic medication on cardiovascular function during IVS. Accordingly, we compared mean blood pressure (MBP) and heart rate (HR) between patients who regularly take antipsychotic drugs and patients who do not. METHODS: Thirty-seven patients with ID were enrolled in this study. All participants were outpatients of Special Care Dentistry of general hospital and received dental treatment under IVS performed with a combination of midazolam and propofol. Eighteen patients regularly took antipsychotics (medication group), and 19 patients were not currently taking antipsychotics (non-medication group). MBP, HR, dose, and effect-site concentration of intravenous sedative medications were measured at three points: 'before IVS', 'at optimal sedation', and 'during dental treatment'. RESULTS: The magnitude of reduction of MBP was significantly smaller in the medication group than in the non-medication group (P < 0.023). However, there were no differences in MBP, HR, dose, and effect-site concentration of midazolam and propofol between groups at any point. CONCLUSION: These results suggest that antipsychotic medication may not have clinically significant adverse effects on cardiovascular fluctuations during dental treatment under IVS for persons with ID.
Journal of intellectual disability research : JIDR, 2022 · doi:10.1111/jir.12913