INTRODUCTION:

The most common reason for administration of pre – anxiety medication is to reduce awareness of surgery and relieve anxiety. Particulary, in oral surgical procedures it has been utilized extensively for clinical studies and is capable of testing anxiolytics, sedatives, antibiotics, and analgesics.[1] Fear and anxiety associated with oral surgical procedures have been well documented and are thought to represent a model of acute stressors.[2] Dental anxiety represents a specific situational and anticipatory state that can be identified and classified using validated specially-designed questionnaires.[3,4]

For example, the Norman and Corah Questionnaire [5,6] has been shown to differenciate fearful and regularly attending dental patients.[7] Anticipation of oral surgical procedures induces a physiological changes in the features of anxious state. These include increase in the blood pressure and heart rate before the treatment, which further increases during minor oral surgical procedures. [8] Heart rate variation, is a non invasive measure of integrated sympathovagal function which is shown to reflect various emotional states. [9] Most studies of pharmacologic management of dental anxiety have focused on therapeutic issues such as reducing patients’ anxiety before injection of anaesthetic agent, decreasing intra operative anxiety, and reducing the effect during post-operative recovery. Benzodiazepine anxiolytics, including midazolam and diazepam, have been used considerably as oral premedication or intravenous sedation in standard dental practice apparently based empirically on the benzodiazepine indication for generalized anxiety disorders. Recent studies have evaluated the amnestic properties of benzodiazepines. [10–12]

AIM:

The aim of this study was to assess the behavioral effects and the changes in the anxiety level of adults before and after administration of Alprazolam.

MATERIAL AND METHODS:

Study design:

Place of study - Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Chennai.

Source of Data - Saveetha Dental College and Hospital, Chennai.

Sample Description - Two groups (10 patients each) - One group given Alprazolam (0.25mg) and one without any drug.

Selection Criteria:

Inclusion Criteria:

Patients undergoing third molar surgery.

Exclusion Criteria:

Medically compromised patients.

Material/Equipment for the study:

Norman and Corah Dental questionnaire.

Blood pressure and pulse rate before and during the surgery

Methodology:

Norman and Corah dental anxiety questionnaire was given to each of the two groups who were advised third molar surgery. The study group was given Alprazolam 0.25mg) while the control group was not given any drug. Blood pressure and pulse rate was measured before giving the drug and during the surgery.

1. If you had to go to the dentist tomorrow for a check-up, how would you feel about it?

a. I would look forward to it as a reasonably enjoyable experience.

b. I wouldn’t care one way or the other

c. I would be a little uneasy about it

d. I would be afraid that it would be unpleasant and painful.

e. I would be very frightened of what the dentist would do.

2. When you are waiting in the dentist’s office for yout turn in the chair, how do you feel

a. Relaxed

b. A little uneasy

c. Tense

d. Anxious

e. So anxious that I sometimes break out in a sweat or almost feel physically sick

3. When you are in the dentist’s chair waiting while the dentist gets the drill ready to begin working on your teeth, how do you feel?

a. Relaxed

b. A little uneasy

c. Tense

d. Anxious

e. So anxious that I sometimes break out in a sweat or almost feel physically sick

4. Imagine you are in the dentist’s chair to have your teeth removed. While you are waiting and the oral surgeon is getting out the instruments which will be used to remove your tooth, how do you feel?

a. Relaxed

b. A little uneasy

c. Tense

d. Anxious

e. So anxious that I sometimes break out in a sweat or almost feel physically sick

Scoring the Dental Anxiety scale, revised (DAS-R)

a = 1 b = 2 c = 3 d = 4 e = 5 Total Possible = 20

RESULTS:

Fig. Norman Corah questionnaire

The questionnaire results showed that 50% of the patients were tensed, 40% were anxious and only 10% patients were relaxed. Statistical analysis was done by independent t - test.The blood pressure after giving Alprazolam was not statistically significant (0.23, 0.156). The pulse rate after giving Alprazolam was statistically significant (0.007).

DISCUSSION:

This study was designed to assess the effect of Alprazolam in reduction of blood pressure and pulse rate. In agreement with the Ethical Committee, no placebo was included in the trial, to avoid unwanted effects caused by stress and anxiety. [13] Oral administration of premedications in now largely recommended because it is easy to use and avoids painful injection. [14,15].

The comparison of the two groups showed no difference in blood pressure and pulse rate before premedication. Both systolic and diastolic pressure remained same in both the groups after administration of Alprazolam but there was a significant difference in the pulse rates after the administration of Alprazolam.

The low dosages of alprazolam were less effectual for reducing the anxiety experienced during oral surgery than expected. The anxiety caused by generalized anxiety disorder is reduced by 0.50 mg alprazolam given twice daily.[16,20] The Physician’s Desk Referenfce[17]says that 0.25 to 0.50 mg alprazolam should be given thrice daily as the starting dose for treatment of generalized anxiety disorder. Alprazolam when administered for an acute, stressful experience is less effective thanwhen taken daily for chronic anxiety. Milgromet a [18] found that midazolam in combination with fentanyl or with fentanyl and methohexitalreduced anxiety during oral surgery. However, Kaufman et al [19] found that 0.25 mg triazolamreduced anxiety associated with oral surgery. The current study suggests that a dose of 0.25 mg of alprazolam is reduces the pulse rate of the patient to a certain extent during oral surgery.

CONCLUSION:

From this study we conclude that Alprazolam can be given for ASA I patients to control their anxiety levels by decreasing their pulse rate. Further studies should be done by increasing the sample size for accurate results and also VAS parameter should be included for pain assessment.

REFERENCES:

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Received on 08.01.2018 Modified on 19.02.2018

Research J. Pharm. and Tech 2018; 11(8):3389-3391.

DOI: 10.5958/0974-360X.2018.00624.8