Recovery following intravenous sedation during dental surgery performed under local anesthesia

Recovery of psychomotor and perceptual performance from two combinations of intravenous sedatives was assessed in 124 oral surgical patients undergoing third molar extractions under local infiltration anesthesia. Ninety-four patients in the experimental group received 15 mg of diazepam and 20 to 200 mg of methohexital intravenously on one occasion and 12.5 mg of diazepam, 20 to 200 mg of methohexital, and 0.1 mg of fentanyl intravenously on another occasion in a randomized, crossover design. Thirty patients in the control group received saline placebo intravenously during a single surgery. Both drug combinations produced significantly prolonged decrements in performance in comparison to placebo. Reduction in the diazepam dose from 15 to 12.5 mg and the addition of fentanyl, a short-acting narcotic, produced greater sedation without prolonging recovery. Psychomotor function recovered to preoperative levels before perceptual performance. These results show that postsurgical deficits in psychomotor and perceptual function result from the sedative drugs and not from the effects of local anesthetics or physiologic and psychological responses to surgery. These results also suggest that psychomotor tests are inappropriate measures of recovery and that superior sedation with rapid recovery may be achieved with reduced doses of longer acting agents such as diazepam and with the addition of shorter acting agents that do not prolong recovery.