J Korean Dent Soc Anesthesiol.  2012 Jun;12(2):105-109. 10.17245/jkdsa.2012.12.2.105.

Propofol Target Controlled Infusion (TCI) Sedation for Dental Treatment in the Exaggerated Gag Reflex Patient

Affiliations
  • 1Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea. stone90@snu.ac.kr
  • 2Department of Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.
  • 3Clinic for Persons with Disabilities, Seoul National University Dental Hospital, Seoul, Korea.

Abstract

The gag reflex is a physiological reaction, but, an exaggerated gag reflex can be a severe limitation not only to treat dental caries but also to do oral exam. Procedures such as surface anesthesia of the palate and pharyngeral area, sedation, or general anesthesia can be options as behavioral management. But, there are no golden rule for the sever gag reflex patients. We present a case report of propofol intravenous sedation using TCI pump for simple dental treatment. A 44-year-old man, who had past history of general anesthesia for dental treatment because of severe gag reflex, was scheduled intravenous sedation for simple dental treatment. After 8 hour fasting he entered the clinic for persons with disabilities. We explained about intravenous deep sedation and got informed consent. First, we kept intravenous catheter (22G) in the arm and started monitoring ECG, non-invasive blood pressure, pulse oximetry and end-tidal CO2 through nasal cannula. We started propofol infusion with TCI pump at the target concentration of 3 mcg/ml. The patient became sedated, but he showed involuntary movement during dental treatment, so we increased the target concentration to 4 mcg/ml. We finished the dental treatment without complications during 30 min. And after 40 min recovery room stay he was discharged without any complications.

Keyword

Gag reflex; Deep sedation; Dental treatment; Propofol

MeSH Terms

Adult
Anesthesia
Anesthesia, General
Arm
Blood Pressure
Catheters
Deep Sedation
Dental Caries
Disabled Persons
Dyskinesias
Electrocardiography
Fasting
Humans
Informed Consent
Oximetry
Palate
Propofol*
Recovery Room
Reflex*
Propofol
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