Dental fear and anxiety is a common problem in pediatric patients. There is considerable variation in techniques used to manage them. Various sedation techniques using many different anesthetic agents have gained considerable popularity over the past few years. Children are not little adults; they differ physically, psychologically, and emotionally. The purpose of this review is to survey recent trends and concerning issues in the rapidly changing field of pediatric sedation. We will study the topic from the perspective of an anesthesiologist. It will also provide information to practitioners on the practice of conscious sedation in dentistry and will also outline the route of administration, pharmacokinetics, and pharmacodynamics of various drugs used.

Background:The advent of laparoscopic surgeries has proved to be beneficial for both patient and surgeon although increased morbidity may result from hemodynamic changes associated with laryngoscopy, intubation, and pneumoperitoneum (PNP).Aim:The present study was prospective, randomized, double-blind conducted to evaluate the efficacy of dexmdetomidine and fentanyl in attenuation of pressor responses to laryngoscopy, intubation, and PNP in laparoscopic cholecystectomy (LC).Materials and Methods:A total of 60 patients of 18–65 years, American Society of Anaesthesiologists Class I/II of either sex for elective LC, were included. The patients were divided into two groups of 30 patients each. Group I received dexmedetomidine and Group II Fentanyl loading 1 μg/kg over 15 min followed by maintenance 0.2 μg/kg/h throughout the PNP.Measurements:Heart rate (HR), systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure (MAP) were recorded preoperatively, 15 min after infusion of study drug, 1 min after induction, 1 min after intubation, throughout the PNP, end of surgery, and until 60 min in postoperative period. Sedation score, visual analog scale score along with modified Alderete score applied in postanesthesia care unit.Results:Control of HR and MAP in Group I was better than in Group II during laryngoscopy, intubation and PNP. There was also smooth extubation, less sedation and better control of pain in Group I than in Group II.Conclusion:The present study demonstrates the benefits of dexmedetomidine over fentanyl in hemodynamic stability and analgesic quality in LC. Thus, it is establishing its utility over for attenuation of pressor response.

Introduction:Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia. Dexmedetomidine when used intrathecally is associated with prolonged motor and sensory block, hemodynamic stability, and less requirement of rescue analgesia in 24 h.Materials and Methods:A prospective, randomized study was carried out which included 60 adult patients between the age group of 20 and 65 years of physical status American Society of Anesthesiologists Classes I and II who underwent infraumbilical surgeries. Group L patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml normal saline while Group LD patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. The two groups were compared with respect to the onset and duration of sensory and motor block and hemodynamic stability.Results:The mean duration of sensory block in Group L was 199.50 ± 7.96 min while in Group LD was 340.20 ± 11.78 min. All the differences were statistically highly significant between the two groups (P < 0.001). Mean duration of motor block in Group L and LD was 150.83 ± 9.17 min and 190.20 ± 9.61 min, respectively. Both the differences were highly significant (P < 0.001).Conclusion:It is concluded that Group LD has early-onset and prolonged duration of sensory and motor block and longer duration of postoperative analgesia than Group L.