Impact of Individualized Comfort-Based Combined Anesthesia Protocol on Elderly Patients Undergoing Outpatient Oral Procedures

<b>Aims/Background</b> Anxiety, fear, and lack of confidence in surgical outcomes can lower the pain threshold of elderly patients. Developing individualized and comfortable anesthesia protocols is critical for optimizing outcomes in elderly patients undergoing oral procedures. This study aimed to investigate the impact of an individualized comfort anesthesia protocol on elderly patients with varying levels of dental anxiety undergoing complex tooth extraction. <b>Methods</b> A retrospective analysis was conducted on 210 elderly patients who underwent complex tooth extractions at the Comfort Oral Treatment VIP Center and Oral Surgery Department of Beijing Stomatological Hospital, Capital Medical University, between December 2022 and May 2024. Patients were categorized into three groups based on Corah's Dental Anxiety Scale: mild dental anxiety (Group G1, 72 cases), moderate dental anxiety (Group G2, 72 cases), and severe dental anxiety (Group G3, 66 cases). Corresponding anesthesia regimens were administered: 0.06 mg/kg, 0.08 mg/kg + 0.03 μg/kg/time, and 0.06 mg/kg + 0.05 μg/kg/time, respectively. Mean arterial pressure (MAP), bispectral index (BIS), and heart rate (HR) were measured at sedation onset (T1), after local anesthesia injection (T2), and at the end of tooth extraction (T3). Sedation onset time, recovery time, discharge time, and adverse reactions were also recorded. <b>Results</b> Repeated measures analysis of variance (ANOVA) revealed significant difference in BIS within groups over time (<i>p</i> < 0.001), with notable group-by-time interactions (<i>p</i> < 0.001) and significant within-group effects (<i>p</i> < 0.001). For MAP, there was a significant within-group effect (<i>p</i> < 0.001) and group-by-time effect (<i>p</i> < 0.001), while the time effect was not statistically significant (<i>p</i> = 0.302). HR demonstrated a significant within-group effect (<i>p</i> < 0.001) but no significant time effects (<i>p</i> = 0.278) and marginally non-significant group-by-time interactions (<i>p</i> = 0.052). Compared with Group G3, Groups G1 and G2 exhibited shorter sedation onset, recovery times, and discharge times (<i>p</i> < 0.001). Additionally, Group G3 had longer sedation onset and recovery times compared to Group G2 (<i>p</i> < 0.001). No significant difference in discharge times was observed between Groups G1 and G2 (<i>p</i> > 0.05). Among the adverse reactions, bradycardia and drowsiness were significantly more frequent in specific groups (<i>p</i> < 0.05). <b>Conclusion</b> An individualized comfort-based anesthesia protocol tailored to the levels of anxiety, fear, and anticipated pain effectively provides optimal sedative and anesthetic outcomes for elderly patients undergoing complex tooth extractions in outpatient settings. This approach exhibits significant benefits in sedation onset, recovery, and discharge times while minimizing adverse reactions, making it a practical and effective option for clinical application.