Twenty-four patients were randomly divided into 2 groups. Intraoperatively, one group received a continuous intravenous infusion of dexmedetomidine alone, whereas the other received a continuous dexmedetomidine infusion plus a small dose of midazolam. Early measurements of patient anxiety and psychomotor performance were lower in patients who had received midazolam. This difference was not seen later in the appointment. An amnesic effect was observed in those patients who received midazolam. This effect, however, did not translate into increased patient satisfaction in the group receiving midazolam. Our findings suggest a prolonged discharge time for patients who had been given midazolam that may be clinically significant. Overall, dexmedetomidine showed an unpredictable sedative response and may be less practical than more common alternatives for oral surgery procedures.Key Words: Dexmedetomidine; Anesthesiology; Oral surgery; Sedation; Third molars.A lpha-2 (a-2) adrenergic receptor agonists were first used as nasal decongestants but soon were valued for the treatment of hypertension and withdrawal symptoms. The sedative and amnesic qualities of clonidine, the prototypic representative of this drug class, fueled interest in its use as an anesthetic adjuvant. It was also quickly noted that, at sedative doses, the normal respiratory drive was unaffected when administered as an intravenous infusion.1-3 Dexmedetomidine (Precedex, Abbott Laboratories), the pharmacologically active dextroisomer of medetomidine, like clonidine, has an imidazoline structure and is a potent and selective agonist of the a-2 adrenoceptor. Compared with clonidine, dexmedetomidine shows 8 times greater selectivity for a-2 than a-1 receptors and is considered a full agonist. It has been used in veterinary anesthesiology for more than 20 years and has demonstrated dose-dependent sympatholytic, sedative, and analgesic properties in human volunteers. [4][5][6] Dexmedetomidine, when administered in the perioperative period, has been shown to reduce the dose requirements of other anesthetics and attenuate the sympathetic response to stressful events. [7][8][9][10]

The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: "stabilization of vital signs/decreased depth of general anesthesia" (92.9%, 26/28) and "improved patient recovery" (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.

Our aim was to characterize effectiveness and complications in children receiving oral midazolam alone, nasal midazolam alone, or oral midazolam with other sedatives. Children received oral midazolam alone, nasal midazolam, or oral midazolam in combination with other sedative medications. All subjects received a presedation history and physical examination and were sedated per protocol by any of 28 resident providers under attending supervision. Sedations were rated for success and complications by clinicians. Postoperative complications were assessed by trained staff up to 48 hours postoperatively. Seven hundred and one encounters, completed over 24 months, yielded 650 usable sedations. The majority of children were healthy (469; 68.2%) and 86% (532) weighed between 10 and 25 kg. Sedations were deemed successful in about 80% of cases. Planned treatment was completed in over 85% of encounters. Oral midazolam alone yielded the best behavior. Physical assessment factors of behavior and age were correlated (P ¼ .035) with effectiveness. Hiccups and a positive medical history were significantly related (P ¼ .049). Side effects of either nausea/vomiting, dysphoria, or hiccups occurred in less than 10% of cases. All 3 regimens were effective with minimal postoperative complications.

The purpose of this study was to test the null hypothesis that children with environmental tobacco smoke (ETS) exposure (also known as passive smoke exposure) do not demonstrate an increased likelihood of adverse respiratory events during or while recovering from general anesthesia administered for treatment of early childhood caries. Parents of children (ages 19 months-12 years) preparing to receive general anesthesia for the purpose of dental restorative procedures were interviewed regarding the child's risk for ETS. Children were observed during and after the procedure by a standardized dentist anesthesiologist and postanesthesia care unit nurse who independently recorded severity of 6 types of adverse respiratory events-coughing, laryngospasm, bronchospasm, breath holding, hypersecretion, and airway obstruction. Data from 99 children were analyzed. The children for whom ETS was reported were signicantly older than their ETS-free counterparts (P ¼ .03). If the primary caregiver smoked, there was a signicantly higher incidence of smoking by other members of the family (P , .0001) as well as smoking in the house (P , .0005). There were no signicant differences between the adverse respiratory outcomes of the ETS (þ) and ETS (À) groups. The ETS (þ) children did have signicantly longer recovery times (P , .0001) despite not having signicantly more dental caries (P ¼ .38) or longer procedure times. ETS is a poor indicator of postgeneral anesthesia respiratory morbidity in children being treated for early childhood caries.