{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:04:09Z","timestamp":1783775049386,"version":"3.55.0"},"reference-count":33,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p>Some patients with intellectual disabilities spend longer than others in emergence from ambulatory general anesthesia for dental treatment. Although antiepileptic drugs and anesthetics might be involved, an independent predictor for delay of the emergence remains unclear. Thus, a purpose of this study is to identify independent factors affecting the delay of emergence from general anesthesia. This was a retrospective cohort study in dental patients with intellectual disabilities. Patients in need of sedative premedication were removed from participants. The outcome was time until emergence from general anesthesia. Stepwise multivariate regression analysis was used to extract independent factors affecting the outcome. Antiepileptic drugs and anesthetic parameters were included as predictor variables. The study included 102 cases. Clobazam, clonazepam, and phenobarbital were shown to be independent determinants of emergence time. Parameters relating to anesthetics, patients' backgrounds, and dental treatment were not independent factors. Delay in emergence time in ambulatory general anesthesia is likely to be related to the antiepileptic drugs of benzodiazepine or barbiturates in patients with intellectual disability.<\/jats:p>","DOI":"10.2344\/0003-3006-62.1.8","type":"journal-article","created":{"date-parts":[[2015,4,7]],"date-time":"2015-04-07T18:14:33Z","timestamp":1428430473000},"page":"8-13","source":"Crossref","is-referenced-by-count":23,"title":["Independent Predictors of Delay in Emergence From General Anesthesia"],"prefix":"10.2344","volume":"62","author":[{"given":"Shigeru","family":"Maeda","sequence":"first","affiliation":[{"name":"Department of Dental Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumiko","family":"Tomoyasu","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology and Special Care Dentistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minako","family":"Ishii-Maruhama","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiko","family":"Egusa","sequence":"additional","affiliation":[{"name":"Special Needs Dentistry, Okayama University Hospital. Okayama, Japan, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Miyawaki","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology and Special Care Dentistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","reference":[{"key":"i0003-3006-62-1-8-b01","series-title":"Paediatr Anaesth","first-page":"748","article-title":"Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial","volume":"19","author":"Konig\n              MW,","year":"2009","unstructured":"Konig\n              MW, \n            \n              Varughese\n              AM, \n            \n              Brennen\n              KA, \n            et al\n          . 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J Oral Maxillofac Surg. 2010;68:2554\u20132557."},{"key":"i0003-3006-62-1-8-b03","series-title":"J Intellect Disabil Res","first-page":"253","article-title":"Assessment of patients with intellectual disability using the International Classification of Functioning, Disability and Health to evaluate dental treatment tolerability","volume":"49","author":"Maeda\n              S,","year":"2005","unstructured":"Maeda\n              S, \n            \n              Kita\n              F, \n            \n              Miyawaki\n              T, \n            et al\n          . Assessment of patients with intellectual disability using the International Classification of Functioning, Disability and Health to evaluate dental treatment tolerability. J Intellect Disabil Res. 2005;49:253\u2013259."},{"key":"i0003-3006-62-1-8-b04","series-title":"Anesthesiology","first-page":"703","article-title":"Ultrasound-guided multilevel paravertebral blocks and total intravenous anesthesia improve the quality of recovery after ambulatory breast tumor resection","volume":"120","author":"Abdallah\n              FW,","year":"2014","unstructured":"Abdallah\n              FW, \n            \n              Morgan\n              PJ, \n            \n              Cil\n              T, \n            et al\n          . Ultrasound-guided multilevel paravertebral blocks and total intravenous anesthesia improve the quality of recovery after ambulatory breast tumor resection. 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Philadelphia, Pa: Churchill Livingstone Elsevier;2010:769\u2013824."},{"key":"i0003-3006-62-1-8-b08","series-title":"J Oral Maxillofac Surg","first-page":"1315","article-title":"Midazolam is associated with delay in recovery and agitation after ambulatory general anesthesia for dental treatment in patients with disabilities: a retrospective cohort study","volume":"70","author":"Maeda\n              S,","year":"2012","unstructured":"Maeda\n              S, \n            \n              Tomoyasu\n              Y, \n            \n              Higuchi\n              H, \n            \n              Mori\n              T, \n            \n              Egusa\n              M, \n            \n              Miyawaki\n              T.\n            \n          \n          Midazolam is associated with delay in recovery and agitation after ambulatory general anesthesia for dental treatment in patients with disabilities: a retrospective cohort study. 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Pharmacotherapy. 2012;32:932\u2013942."},{"key":"i0003-3006-62-1-8-b10","series-title":"Br J Clin Pharmacol","first-page":"768","article-title":"Effects of ketoconazole and valproic acid on the pharmacokinetics of the next generation NNRTI, lersivirine (UK-453,061), in healthy adult subjects","volume":"73","author":"Langdon\n              G,","year":"2012","unstructured":"Langdon\n              G, \n            \n              Davis\n              J, \n            \n              Layton\n              G, \n            \n              Chong\n              CL, \n            \n              Weissgerber\n              G, \n            \n              Vourvahis\n              M.\n            \n          \n          Effects of ketoconazole and valproic acid on the pharmacokinetics of the next generation NNRTI, lersivirine (UK-453,061), in healthy adult subjects. Br J Clin Pharmacol. 2012;73:768\u2013775."},{"key":"i0003-3006-62-1-8-b11","series-title":"Expert Opin Drug Metab Toxicol","first-page":"1501","article-title":"and phenobarbital induce murine CYP2B genes by independent mechanisms","volume":"5","author":"Audet-Walsh\n              E,","year":"2009","unstructured":"Audet-Walsh\n              E, \n            \n              Auclair-Vincent\n              S, \n            \n              Anderson A.\n              Glucocorticoids\n            \n          \n          and phenobarbital induce murine CYP2B genes by independent mechanisms. 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J Biol Chem. 1999;274:6043\u20136046."},{"key":"i0003-3006-62-1-8-b14","series-title":"Anesthesiology","first-page":"717","article-title":"Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial","volume":"117","author":"Mashour\n              GA,","year":"2012","unstructured":"Mashour\n              GA, \n            \n              Shanks\n              A, \n            \n              Tremper\n              KK, \n            et al\n          . Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial. 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J Anesth. 2011;25:946\u2013949."},{"key":"i0003-3006-62-1-8-b17","series-title":"CNS Neurosci Ther","first-page":"95","article-title":"The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties","volume":"14","author":"Kotani\n              Y,","year":"2008","unstructured":"Kotani\n              Y, \n            \n              Shimazawa\n              M, \n            \n              Yoshimura\n              S, \n            \n              Iwama\n              T, \n            \n              Hara\n              H.\n            \n          \n          The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties. CNS Neurosci Ther. 2008;14:95\u2013106."},{"key":"i0003-3006-62-1-8-b18","series-title":"Pharmacol Rev","first-page":"243","article-title":"Enhancement of GABAergic activity: neuropharmacological effects of benzodiazepines and therapeutic use in anesthesiology","volume":"63","author":"Saari\n              TI,","year":"2011","unstructured":"Saari\n              TI, \n            \n              Uusi-Oukari\n              M, \n            \n              Ahonen\n              J, \n            \n              Olkkola\n              KT.\n            \n          \n          Enhancement of GABAergic activity: neuropharmacological effects of benzodiazepines and therapeutic use in anesthesiology. 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Eur J Pharmacol. 2013;718:10\u201316."},{"key":"i0003-3006-62-1-8-b33","series-title":"Pharmacogenomics J","first-page":"359","article-title":"Neurological toxicity after phenytoin infusion in a pediatric patient with epilepsy: influence of CYP2C9, CYP2C19 and ABCB1 genetic polymorphisms","volume":"13","author":"Dorado\n              P,","year":"2013","unstructured":"Dorado\n              P, \n            \n              Lopez-Torres\n              E, \n            \n              Penas-Lledo\n              EM, \n            \n              Martinez-Anton\n              J, \n            \n              Llerena\n              A.\n            \n          \n          Neurological toxicity after phenytoin infusion in a pediatric patient with epilepsy: influence of CYP2C9, CYP2C19 and ABCB1 genetic polymorphisms. 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