A Comparison of Dexmedetomidine Sedation With and Without Midazolam for Dental Implant Surgery

Abstract

Dexmedetomidine (DEX) has a minimal respiratory depressive effect, which is beneficial for dentistry; however, it has the disadvantage of permitting an intraoperative arousal response such that the patient appears to be suddenly no longer sedated, and it has a variable amnestic effect. Since midazolam (MDZ) in an appropriate dose has a profound amnesic effect, we investigated whether additional MDZ compensates for the disadvantage of DEX and enables a better quality of sedation. Forty-three subjects were randomly divided into 4 groups. In group 1, MDZ (0.02 mg/kg) was administered intravenously, followed by a dose of 0.01 mg/kg every 45 minutes. After the first dose of MDZ, preloading with DEX (2 µg/kg/h for 10 minutes) was started and maintained with a dosage of 0.5 µg/kg/h. In group 2, MDZ was infused in the same manner as in group 1, followed by preloading with DEX (1 µg/kg/h for 10 minutes) and maintenance (0.3 µg/kg/h). In group 3, MDZ was infused 0.03 mg/kg, and a dose of 0.01 mg/kg was given every 30 minutes; DEX was administered at the same as in group 2. In group 4, DEX was infused using the same method as in group 1 without MDZ. The sedation levels, amnesia, and patient satisfaction were also investigated. Group 2 had a lower sedation level and a poor evaluation during the first half of the operation. Group 4 did not exhibit an amnesic effect at the beginning of the operation. An evaluation of the degree of patient satisfaction did not reveal any differences among the groups. Optimal sedation was achieved through the combined use of MDZ (0.02 mg/kg with the addition of 0.01 mg/kg every 45 minutes) and DEX (2 µg/kg/h for 10 minutes followed by 0.5 µg/kg/h).

Dexmedetomidine and Midazolam Sedation Reduces Unexpected Patient Movement During Dental Surgery Compared With Propofol and Midazolam Sedation

“…Dexmedetomidine is often used in combination with midazolam. 36 Thus, although the present results do not reflect the 2 sedatives when used alone, the authors believe that the relevant difference between the 2 groups in this study indicates the clinical effectiveness of this drug. Third, painful stimuli could be a cause of unexpected patient movement.…”

“…This result suggests that dexmedetomidine requires a certain dose of additional midazolam to achieve the optimal sedation in a clinical setting, similar to that recommended by a previous study that used a combined dose of dexmedetomidine and midazolam. 36 Moreover, regardless of the midazolam dose, care must be taken when using dexmedetomidine, because prolonged recovery associated with dexmedetomidine has been reported. 37 This study had several limitations.…”

“…Conclusion: Dexmedetomidine and midazolam sedation decreases unexpected patient movement during dental surgery compared with propofol and midazolam sedation. Ó 2018 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 77: [29][30][31][32][33][34][35][36][37][38][39][40][41]2019 Monitored anesthesia care with intravenous sedation is commonly used in various procedures. [1][2][3] Although lowering a patient's response to noxious stimuli is an advantage of sedation, unexpected patient movement can still occur.…”

Randomized and controlled study comparing patient controlled and radiologist controlled intra‐procedural conscious sedation, using midazolam and fentanyl, for patients undergoing insertion of a central venous line

“…This type method is well established in the postoperative setting; however, there is emerging use of this method during the procedure as an alternative means of providing intra‐procedural sedation. In other procedural situations such as dentistry and endoscopy, PCS has been studied and shown to have some advantages . With PCS, anxiolysis and pain relief can be achieved with a reduced risk of overdose.…”

“…In other procedural situations such as dentistry and endoscopy, PCS has been studied and shown to have some advantages. 8,9 With PCS, anxiolysis and pain relief can be achieved with a reduced risk of overdose. It has been shown to enhance patient satisfaction.…”