Intravenous Sedation with Low-Dose Dexmedetomidine: Its Potential for Use in Dentistry

Ogawa, Satoshi; Seino, Hiroaki; H, Ito; Yamazaki, Satoru; Ganzberg, Steven; Kawaai, Hiroyoshi

doi:10.2344/0003-3006-55.3.82

Cited by 31 publications

(31 citation statements)

References 21 publications

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“…The addition of clonidine to local anaesthetics for peripheral nerve blockade has been reported to enhance and prolong anaesthesia. The use of dexmedetomidine for conscious sedation in dentistry has been investigated, but its suitability as an analgesic in the outpatient and day‐case setting is as yet uncertain because of reported side effects. Whilst the alpha‐2 receptor agonists improve analgesia and reduce opioid requirements, their use is currently limited by side effects including bradycardia, hypotension and excessive sedation.…”

Section: The Pain Systemmentioning

confidence: 99%

Pain pathways and pre‐emptive and protective analgesia for oral surgery

et al. 2013

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Aim To describe the scientific basis of the contemporary management of pain after oral surgery. Materials and methods A review of the literature describing the concepts of pre‐emptive and protective analgesia and evidence‐based practice in the context of managing pain after oral surgery. Results Pain is the consequence of the interplay of numerous chemical mediators and a dynamic and plastic neuronal system, and so pain prevention and management requires the use of different classes of analgesic that act by different mechanisms and at different sites of action, ideally resulting in synergistic analgesia with few side effects. Conclusions Management can be challenging, particularly as much oral surgery is undertaken on an outpatient and day‐case basis, but significant improvement can be made to the patient's experience by considering the underlying mechanisms.

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Section: The Pain Systemmentioning

confidence: 99%

Pain pathways and pre‐emptive and protective analgesia for oral surgery

et al. 2013

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“…Due to its significant properties as sedative and analgesic and safe respiratory profile, coupled with its ease of use and antisialagogue properties, dexmedetomidine was thought to be very useful in dental/oral procedures 16. A randomized, double-blind study compared dexmedetomidine and midazolam for intravenous sedation during third molar surgery under local anesthesia 17.…”

Section: Dexmedetomidine Use During Dental Proceduresmentioning

confidence: 99%

Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures

Shukry¹,

Miller²

2010

TCRM

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Dexmedetomidine was introduced two decades ago as a sedative and supplement to sedation in the intensive care unit for patients whose trachea was intubated. However, since that time dexmedetomidine has been commonly used as a sedative and hypnotic for patients undergoing procedures without the need for tracheal intubation. This review focuses on the application of dexmedetomidine as a sedative and/or total anesthetic in patients undergoing procedures without the need for tracheal intubation. Dexmedetomidine was used for sedation in monitored anesthesia care (MAC), airway procedures including fiberoptic bronchoscopy, dental procedures, ophthalmological procedures, head and neck procedures, neurosurgery, and vascular surgery. Additionally, dexmedetomidine was used for the sedation of pediatric patients undergoing different type of procedures such as cardiac catheterization and magnetic resonance imaging. Dexmedetomidine loading dose ranged from 0.5 to 5 μg kg−1, and infusion dose ranged from 0.2 to 10 μg kg−1 h−1. Dexmedetomidine was administered in conjunction with local anesthesia and/or other sedatives. Ketamine was administered with dexmedetomidine and opposed its bradycardiac effects. Dexmedetomidine may by useful in patients needing sedation without tracheal intubation. The literature suggests potential use of dexmedetomidine solely or as an adjunctive agent to other sedation agents. Dexmedetomidine was especially useful when spontaneous breathing was essential such as in procedures on the airway, or when sudden awakening from sedation was required such as for cooperative clinical examination during craniotomies.

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“…Since then its clinical application has expanded to include neurosurgery, pediatric procedural sedation, awake fiber-optic intubation, cardiac surgery, bariatric surgery, and dental procedures. 5,[8][9][10][11][12][13][14] Its use as a single agent during dental procedures under intravenous sedation has been reported in several studies. Dexmedetomidine has been shown to be comparable to or better than midazolam as a single agent in third-molar extractions 15,16 ; however, it does not produce consistent amnestic effects.…”

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confidence: 99%

Dexmedetomidine, Ketamine, and Midazolam for Oral Rehabilitation: A Case Report

Kim¹,

Peskin

2015

Anesthesia Progress

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Intravenous sedation is frequently provided by anesthesiologists for phobic patients undergoing elective dental treatment in outpatient settings. Propofol is one of the most commonly used anesthetic agents that can result in apnea and respiratory depression, thereby posing potential difficulties with perioperative airway management. Dexmedetomidine has been utilized successfully in intravenous sedation for a wide variety of procedures and holds potential as an alternative to propofol in outpatient dental settings. However, as a single agent, it may not provide adequate depth of sedation and analgesia for oral rehabilitation. In this case report we demonstrate an effective alternative intravenous deep-sedation technique for an adult phobic patient undergoing oral rehabilitation utilizing 3 agents in combination: dexmedetomidine, ketamine, and midazolam. This combination of agents may be especially useful for those patients with a history of substance abuse, where administration of opioids may be undesirable or contraindicated.

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Intravenous Sedation with Low-Dose Dexmedetomidine: Its Potential for Use in Dentistry

Cited by 31 publications

References 21 publications

Pain pathways and pre‐emptive and protective analgesia for oral surgery

Pain pathways and pre‐emptive and protective analgesia for oral surgery

Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures

Dexmedetomidine, Ketamine, and Midazolam for Oral Rehabilitation: A Case Report

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