J Dent Anesth Pain Med.  2016 Mar;16(1):67-71. 10.17245/jdapm.2016.16.1.67.

Deep sedation for dental treatment in a Down syndrome patient with Eisenmenger syndrome: A case report

• Chi SI
• Kim HJ
• Seo KS

• KMID: 2308768
• DOI: http://doi.org/10.17245/jdapm.2016.16.1.67

Abstract

Eisenmenger syndrome (ES) is characterized by pulmonary arterial hypertension and right-to-left shunting. The signs and symptoms of ES include cyanosis, shortness of breath, fatigue, hemoptysis, and sudden death. In patients with ES, it is important that the systemic and pulmonary circulations be properly distributed and maintained. General dental treatment is not known to be particularly dangerous. To control pain and anxiety, local anesthetics without epinephrine are usually recommended. However, in cases of difficulty of cooperation, general anesthesia for dental treatment makes the condition worse. In the present case, intravenous deep sedation with propofol and remifentanil was administered for behavioral management during dental treatment successfully.

Keyword

Deep sedation; Dental treatment; Down syndrome; Eisenmenger syndrome; Propofol; Remifentanil

MeSH Terms

Anesthesia, General
Anesthetics, Local
Anxiety
Cyanosis
Death, Sudden
Deep Sedation*
Down Syndrome*
Dyspnea
Eisenmenger Complex*
Epinephrine
Fatigue
Hemoptysis
Humans
Hypertension
Propofol
Anesthetics, Local
Epinephrine
Propofol

Figure

• 

  Fig. 1 After cardiac catheterization, a right-to-left shunt and severe pulmonary hypertension are observed. (Yellow numbers indicate oxygen saturation and black numbers indicate blood pressure).

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  Fig. 2 Capnography was measured while oxygen was being supplied through a nasal cannula. A mouth gag is used to access the mouth under deep sedation, and a rubber dam is used to prevent water from entering the oral cavity.

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  Fig. 3 Changes in the target concentrations of perioperative propofol and remifentanil and patient vital signs.

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