J Dent Anesth Pain Med.  2016 Mar;16(1):55-59. 10.17245/jdapm.2016.16.1.55.

Dexmedetomidine intravenous sedation using a patient-controlled sedation infusion pump: a case report

Affiliations
  • 1Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea. stone90@snu.ac.kr

Abstract

Dental treatment under sedation requires various sedation depths depending on the invasiveness of the procedure and patient drug sensitivity. Inappropriate sedation depth may cause patient discomfort or endangerment. For these reasons, patient-controlled sedation (PCS) pumps are commonly used. Patients are able to control the sedation depths themselves by pushing the demand button after the practitioner sets up the bolus dose and lock-out time. Dexmedetomidine is an α-2 adrenoreceptor agonist with sedative, analgesic, and anxiolytic properties. It has been widely used for sedation for its minimal respiratory depression; however, there are few studies on PCS using dexmedetomidine. This study assessed the applicability of dexmedetomidine to PCS.

Keyword

Conscious sedation; Dexmedetomidine; Patient-controlled sedation

MeSH Terms

Conscious Sedation
Dexmedetomidine*
Humans
Infusion Pumps*
Respiratory Insufficiency
Dexmedetomidine

Figure

  • Fig. 1 Upper Left: Patient with nasal cannula and Bispectral index sensor, with 3 L/min O2 supplied through the nasal cannula. Upper right: Demand button on patient's hand, with a Velcro belt that prevents the patient from missing the button; Lower left: Upon pressing the button, the patient is administered dexmedetomidine; Lower right: If the patient presses the button more than once within 1 min, the lock-out time is activated.

  • Fig. 2 Patient vital signs and demand button presses.

  • Fig. 3 Bispectral index and calculated plasma concentrations of dexmedetomidine [20]. BIS: Bispectral index, Cp: plasma concentration of dexmedetomidine


Cited by  3 articles

Smart syringe pumps for drug infusion during dental intravenous sedation
Kwang-Suk Seo, Kiyoung Lee
J Dent Anesth Pain Med. 2016;16(3):165-173.    doi: 10.17245/jdapm.2016.16.3.165.

Smart syringe pumps for drug infusion during dental intravenous sedation
Kwang-Suk Seo, Kiyoung Lee
J Dent Anesth Pain Med. 2016;16(3):165-173.    doi: 10.17245/jdapm.2016.16.3.165.

Anesthetic management for simultaneous drug-induced sleep endoscopy and maxillomandibular advancement in a patient with obstructive sleep apnea
Tae Seong Kuk, Eunsun So, Myong-Hwan Karm, Jimin Kim, Seong In Chi, Hyun Jeong Kim, Kwang-Suk Seo, Sung Woon On, Jin-Young Choi
J Dent Anesth Pain Med. 2017;17(1):71-76.    doi: 10.17245/jdapm.2017.17.1.71.


Reference

1. Senel AC, Altintas NY, Senel FC, Pampu A, Tosun E, Ungor C, et al. Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: Failure and complications. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114:592–596.
2. Rodrigo C. Patient-controlled sedation. Anesth Prog. 1998; 45:117–126.
3. Ustun Y, Gunduz M, Erdogan O, Benlidayi ME. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg. 2006; 64:1353–1358.
Article
4. Davies JG, Wilson KI, Clements AL. A joint approach to treating dental phobia: A re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on. Br Dent J. 2011; 211:159–162.
Article
5. Sbaraglia P. Sedation or general anaesthesia requirements. A literature review of dental phobia. Ont Dent. 1997; 74:19–22.
6. Korean Society for Intravenous Anesthesia. Sedation. 2004. Seoul: Seoul Eui-hak Publishing & Printing Co.
7. Rudkin GE, Osborne GA, Curtis NJ. Intra-operative patient-controlled sedation. Anaesthesia. 1991; 46:90–92.
Article
8. Osborne GA, Rudkin GE, Curtis NJ, Vickers D, Craker AJ. Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with anaesthetist-administered midazolam and fentanyl. Anaesthesia. 1991; 46:553–556.
Article
9. Oei-Lim VL, Kalkman CJ, Makkes PC, Ooms WG. Patient-controlled versus anesthesiologist-controlled conscious sedation with propofol for dental treatment in anxious patients. Anesth Analg. 1998; 86:967–972.
Article
10. Lok IH, Chan MT, Chan DL, Cheung LP, Haines CJ, Yuen PM. A prospective randomized trial comparing patient-controlled sedation using propofol and alfentanil and physician-administered sedation using diazepam and pethidine during transvaginal ultrasound-guided oocyte retrieval. Hum Reprod. 2002; 17:2101–2106.
Article
11. Rudkin GE, Osborne GA, Finn BP, Jarvis DA, Vickers D. Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with patient-controlled midazolam. Anaesthesia. 1992; 47:376–381.
Article
12. Garip H, Gurkan Y, Toker K, Goker K. A comparison of midazolam and midazolam with remifentanil for patient-controlled sedation during operations on third molars. Br J Oral Maxillofac Surg. 2007; 45:212–216.
Article
13. Chlan LL, Weinert CR, Skaar DJ, Tracy MF. Patient-controlled sedation: A novel approach to sedation management for mechanically ventilated patients. Chest. 2010; 138:1045–1053.
14. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000; 59:263–268.
15. Lawrence CJ, Prinzen FW, deLange S. The effect of dexmedetomidine on the balance of myocardial energy requirement and oxygen supply and demand. Anesthesia and Analgesia. 1996; 82:544–550.
Article
16. Chrysostomou C, Schmitt CG. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol. 2008; 4:619–627.
Article
17. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans 1. Sedation, ventilation, and metabolic-rate. Anesthesiology. 1992; 77:1125–1133.
Article
18. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000; 59:263–268.
Article
19. Fan TW, Ti LK, Islam I. Comparison of dexmedetomidine and midazolam for conscious sedation in dental surgery monitored by bispectral index. Br J Oral Maxillofac Surg. 2013; 51:428–433.
Article
20. Lee S, Kim BH, Lim K, Stalker D, Wisemandle W, Shin SG, et al. Pharmacokinetics and pharmacodynamics of intravenous dexmedetomidine in healthy korean subjects. J Clin Pharm Ther. 2012; 37:698–703.
Article
Full Text Links
  • JDAPM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr