Does the Time of Day Change the Amount of Anesthesia Required to Perform Wisdom Tooth Removal?

At our institution, we prefer to perform difficult sedations or sedations on more anxious patients early in the morning, while some oral surgeons solely perform all of their sedations in the morning. If research suggests that it is equally successful to perform sedations in the afternoon as the morning, would practices be able to increase the amount of sedations they can perform in a work day and therefore be able to get patients in sooner. The purpose of this study was to evaluate the difference in the amount of anesthesia required to perform wisdom tooth removal between the patients who were seen in the morning verses those seen in the afternoon.

In order to address these issues, we need to identify differences in practitioner sedation preferences and “tolerances” for medications that various patients have secondary to their own anxiety, ADHD, and depression medications, as well as personal habits (alcohol, etc)

A total of 200 healthy individuals (mean age=18.1 years, 50% female) who take no medications for anxiety, depression, ADHD, and who deny alcohol and drug usage were included in this study. None of them have any significant medical history. Of the 200 subjects, 100 were seen from 8:00 am to 11:00 am in the morning, 100 were seen from 1:00 pm to 4:00 pm in the afternoon, and no patients were seen between Noon and 1:00 pm.

Seven faculty members at UIHC who are very consistent with their average sedations, secondary to years of sedation experience, conducted the sedations. It can then be assumed that any deviation from their average sedation such as requiring higher amounts of medication or additional medication (In this case propofol and ketamine) would signify a more difficult sedation and/or surgical case. Analysis was completed on a mg/kg basis in terms of versed, fentanyl, ketamine, and propofol usage to determine if on a mg/kg basis, these medications are required to a further extent in the afternoon versus the morning. This was also looked at in terms of individual faculty members to determine if a particular provider deviates more commonly towards increased sedation requirements in the afternoon versus the morning.

Descriptive statistics were conducted, and the nonparametric Wilcoxon rank-sum test and chi-square test were used to detect the difference in the amount of anesthesia required to perform wisdom tooth removal between two groups of patients (alpha=0.05). There was no significant difference in the usage of propofol and ketamine between the two groups of patients (p>0.05 in each instance), whereas, there was a statistically significant difference found between the two groups with respect to usage of fentanyl (p=0.0148) and versed (p=0.0003). The data showed that the patients seen in the morning were more likely to have greater amounts of fentanyl and versed required than the patients seen in the afternoon (83% vs. 74% for fentanyl; 75% vs. 50%, respectively).

Study findings indicated that the time of day did not cause an increased usage of medication in the afternoon, and providers did not deviate from their normal in terms of medication usage in the afternoon, signifying that patients can be scheduled in the afternoon without added difficulty of sedation.

References:

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2. Witbracht M, Keim NL, Forester S, Widaman A, Laugero K: Female breakfast skippers display a disrupted cortisol rhythm and elevated blood pressure. Physiol Behav. 2015 Mar 1;140:215-21. doi: 10.1016/j.physbeh.2014.12.044. Epub 2014 Dec 27. PMID: 25545767