J Korean Assoc Oral Maxillofac Surg.  2016 Jun;42(3):162-165. 10.5125/jkaoms.2016.42.3.162.

Oral surgery under local anesthesia with dexmedetomidine sedation in a morbidly obese patient with aortic dissection

• Seto M
• Matsuda M
• Narihira K
• Kikuta T

• KMID: 2309259
• DOI: http://doi.org/10.5125/jkaoms.2016.42.3.162

Abstract

We report a case of a morbidly obese man with an aortic aneurysm, in whom dental surgery was performed before elective cardiac surgery. His aortic aneurysm required emergency surgery. However, because of his morbid obesity, elective cardiac surgery was planned. Considering the high risk of infective endocarditis, dental surgery was required. Our patient was at a high risk of aortic rupture caused by hypertension and breathing difficulty in the supine position. Dexmedetomidine (DEX) is an anti-anxiety, sedative, and analgesic medicine that can stabilize circulatory dynamics and minimize blood pressure fluctuations. We administered intravenous DEX for sedation of the patient in Fowler's position. In conclusion, our understanding of the risk factors of DEX enabled us to perform safe invasive oral treatment.

Keyword

Aortic aneurysm; Morbid obesity; Oral surgical procedures; Local anesthetics

MeSH Terms

Anesthesia, Local*
Anesthetics, Local
Aortic Aneurysm
Aortic Rupture
Blood Pressure
Dexmedetomidine*
Emergencies
Endocarditis
Humans
Hypertension
Obesity, Morbid
Oral Surgical Procedures
Respiration
Risk Factors
Supine Position
Surgery, Oral*
Thoracic Surgery
Anesthetics, Local
Dexmedetomidine

Figure

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  Fig. 1 Imaging findings. A. Original panoramic X-ray findings. Periapical lesions are observed in the apical area of the right mandibular third molar, left mandibular first and second molars, and left maxillary central incisor. B. Computed tomography findings (sagittal section image). Cyst-like images are observed in the apical area of the left maxillary lateral incisor and second molar.

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  Fig. 2 Problems in the invasive treatment of this patient.

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  Fig. 3 Summary of the therapeutic procedure. 1⃞: Extraction of the left maxillary lateral second molar and cyst enucleation. 2⃞: Extraction of the left maxillary central incisor and lateral incisor and cyst enucleation. 3⃞: Extraction of the left mandibular first and second molars. 4⃞: Extraction of the right mandibular third molar. Observer's assessment of alertness/sedation (OAA/S) scale: Score level 5=responds readily to name spoken in normal tone, score level 4=lethargic response to name spoken in normal tone, score level 3=responds only after name is called loudly and/or repeatedly, score level 2=responds only after mild prodding or shaking, score level 1=does not respond to mild prodding or shaking. × to ×: sedative duration, ㉧ to ㉧: operative duration.

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