RU2337691C1 - Method of premedication pharmacological correction in outpatient dentistry - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: intervention follows premedication through introduction of psychotropic agents. After intervention 10 minutes before patient leaves the clinic 1% nasal drops Semax are used in amount 6 drops.

EFFECT: fast restoration of mental and motor functions after dental intervention due to application of nootropic agents.

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Description

The invention relates to medicine, namely to anesthesiology in dentistry.

It is known to use the drug anexate (flumazenil) in order to restore psychomotor functions in patients after the use of narcotic and sedative drugs. (The Register of Medicinal Products of Russia. Encyclopedia of Medicines: Annual Collection. Issue 10. - M., “RLS-2003”, 887 pp.).

Anexat is an expensive, potent drug that does not enter the pharmacy network, which can only be used in a hospital, and is intended for intravenous administration, has a narrow spectrum of antagonistic activity, and can only be used by an anesthesiologist.

It is also known to use the drug niketamide, which belongs to the group of analeptics with the aim of pharmacological adaptation of sedation to the conditions of outpatient dental care. (Possible pharmaceutical adaptation of premedication to out-patient dental treatment / Abstr. Of the 8 ^th ECNP Regional Meeting "European Neuropsychopharmacology", Moscow, April 14-16, 2005, P.3042. SGNovikova, EGLobanova, DVNovikov, TVEmelianova). The action of niketamide is associated with the effect on the vasomotor center of the medulla oblongata, leading to its excitation and mediated increase in blood pressure, which may limit the use of this drug in patients with diseases of the cardiovascular system (hypertension, neurocirculatory dystonia of the hypertonic type, etc.).

The objective of the invention is to ensure the adaptation of sedation to the conditions of outpatient dental care, the expansion of indications for the use of the procedure.

The technical result is to reduce the psychosedative effect after sedation.

This is achieved due to the fact that, after a dental intervention, a semax drop of nasal 1% in the amount of 6 drops is used as a drug that reduces the psychosedative effect of the drug for sedation 10 minutes before the patient leaves the clinic.

Semax (heptapeptide) - a nootropic drug (the Register of medicines of Russia. Encyclopedia of drugs. Issue No. 10. - M., Publishing House "RLS-2003", S.749-750.). A synthetic peptide preparation, which is an analog of a fragment of adrenocorticotropic hormone, is completely devoid of hormonal activity. Semax improves mnemonic functions, adaptation of the body to hypoxia, energy processes of the brain, increasing its resistance to stress damage, helps to preserve and accelerates the restoration of mental performance under conditions of neuropsychic fatigue.

Semax is absorbed from the nasal mucosa, is rapidly distributed to all organs and tissues, penetrates the blood-brain barrier. When it gets into the blood, Semax undergoes rather rapid degradation and excretion from the body. Indications for use are intellectual-mnestic disorders in case of vascular lesions of the brain, conditions after traumatic brain injury and neurosurgical operations, astheno-neurotic disorders, etc. Contraindications: acute psychotic conditions, disorders accompanied by anxiety, pregnancy, breastfeeding, diseases of the endocrine system, hypersensitivity to the components of the drug.

The study of neurotropic effects and the effect on the cardiovascular system of anxiolytic drugs in combination with Semax on an outpatient dental appointment. The study was performed on 54 patients who underwent dental interventions under premedication in an outpatient setting. All drugs were administered orally once in minimal single doses.

To assess the patient’s condition, the following set of methods was used: psychological testing, blood pressure measurement, heart rate, ECG recording, EEG, photoplethysmography. Research indicators were recorded: in the initial state (stage I), 40 minutes after the use of a psychotropic drug (stage II), 20 minutes (stage III) and 120 minutes (stage IV) after using Semax.

According to the results of psychological testing, the values of reactive anxiety according to the test of reactive anxiety by Ch.D. Spilberger and Yu.L. Khanin when comparing the results in patients at the second and third stages of the study were almost the same (39.3 and 37.6 points, respectively ) According to the results of the SAN test (Wellness, Activity, Mood) after the use of Semax (stage 111), a statistically significant increase in activity indicators by 10.4% and well-being by 15.3% was noted, while under the influence of a psychotropic drug an increase in the state of health by 7.1% and a fairly pronounced decrease in activity indicator by 15.3%. When comparing the EEG of patients at the II and III stages of the study after the use of Semax, there was a complete absence of a hypnotic effect, a decrease in sedation was expressed against the background of almost equal anxiolytic effect, which is possibly explained by the nootropic activity of Semax. These results were obtained 20 minutes after the use of Semax and remained virtually unchanged after 120 minutes. Clinically, patients under conditions of sedation 10 minutes after the use of Semax felt calm, remained at the same time “contact”, signs of sedation, muscle relaxation and psychomotor depression disappeared.

Thus, the study found that under the influence of Semax there is a significant decrease in the psychosedative effect of psychotropic drugs.

The method is as follows.

The patient is determined by the presence of concomitant somatic pathology, the level of psychoemotional stress, the amount of upcoming dental intervention, blood pressure and heart rate are measured. If the patient has indications, he is sedated, and after a dental intervention, semax drops of 1% nasal drops are administered in the amount of 6 drops (3 drops in each nasal passage) 10 minutes before the patient leaves the clinic.

Dental intervention begins with the onset of the effect of a psychotropic drug (20-40 minutes, which depends on the pharmacological properties and route of administration of the drug for premedication).

Clinical example No. 1.

Patient K. And / B No. 1725.

Complaints: the presence of a deep carious cavity in the 14th tooth, periodically arising pains on the hot. The patient noted the presence of concomitant pathology - stage II hypertension.

The patient is tense, expresses concern about pain during the upcoming treatment. HELL - 135/82 mm Hg, heart rate - 87 beats per minute.

The patient experiences emotional stress of moderate severity.

Objectively: on the chewing surface of the 14th tooth, a carious cavity that communicates with the tooth cavity, probing the bottom of the carious cavity is painful.

Rg: 14 tooth - the carious cavity communicates with the tooth cavity, there are no changes in the periapical tissues.

Diagnosis: chronic pulpitis of 14 teeth, psychoemotional tension of moderate severity.

Treatment: Given the level of emotional stress, the patient underwent premedication - phenazepam 1 tablet (0.001 g). 20 minutes after taking phenazepam, an infiltration anesthesia was performed in the region of the 14 tooth.

40 minutes after taking phenazepam, the patient noted sedation, a decrease in anxiety and tension, blood pressure - 125/72 mm Hg, heart rate - 75 beats per minute.

The patient underwent a dental intervention, 10 minutes before the patient leaves the clinic, Semax nasal drops of 1% are administered in the amount of 6 drops (3 drops in each nasal passage). Before the patient leaves the clinic according to the Bidway test - 0 points (the patient is well versed in space and time, drowsiness is absent), motor functions are fully restored (in the Romberg position it is stable, there is no ataxia, the finger-bearing test performs correctly).

Clinical example No. 2.

Patient N. And / B No. 1139.

Complaints: pain in the area of the root of the tooth 24.

The patient noted the presence of concomitant somatic pathology - a violation of the heart rhythm (paroxysmal tachycardia). He has a strong fear of dental intervention, but despite this, he expresses readiness for treatment. HELL - 140/83 mm RT. Art., heart rate - 83 beats per minute.

Objectively: tooth root 24 is destroyed below the gum level, root tissues are soft when probed, deeply affected by the carious process. Hyperemia, smoothing of the transitional fold in the area of the projection of the root 24 are noted.

X-ray: rarefaction of bone tissue 3 mm in size with fuzzy borders in the region of the apex of the root 24.

Diagnosis: exacerbation of chronic periodontitis of the tooth 24.

Treatment: Given the level of psychoemotional stress and the morbidity of the upcoming intervention, the patient underwent premedication - apodiazepam, sublingually 1 tablet (10 mg.). 20 minutes after taking apodiazepam, an infiltration anesthesia was performed in the area of 24 teeth.

40 minutes after taking apodiazepam, the patient noted sedation, improved mood, blood pressure - 120/70 mm RT. Art., heart rate - 76 beats per minute.

The patient underwent a dental intervention, 10 minutes before the patient leaves the clinic, Semax nasal drops of 1% are administered in the amount of 6 drops (3 drops in each nasal passage). Before the patient leaves the clinic according to the Bidway test - 0 points (the patient is well versed in space and time, drowsiness is absent), motor functions are fully restored (in the Romberg position it is stable, there is no ataxia, the finger-bearing test performs correctly).

Claims (1)

A method of pharmacological correction of sedation in an outpatient dental practice using psychotropic drugs, characterized in that after the dental intervention, semax drops are applied nasal drops 1%, in the amount of 6 drops 10 minutes before the patient leaves the clinic.