Dexmedetomidine Sedation With and Without Midazolam for Third Molar Surgery

Abstract

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]

Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?

“…In addition, Maeda et al 11 chose to evaluate patients undergoing a deeper level of anesthesia than is customarily provided for 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 608 609 610 611 612 613 614 615 616 617 618 619 620 621 622 623 624 625 626 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 644 645 646 647 648 649 650 651 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 routine outpatient third molar surgery in young heathy patients-further limiting the comparisons that can be drawn compared with findings of the present study and those of Smiley and Prior. 10 Although the present study is limited by its retrospective nature and the inherent shortcomings specific to such a design, it is conversely strengthened by an extremely large sample providing the adequate statistical power needed to detect small differences in LOS patterns. The finding that midazolam dose does not meaningfully i...…”

“…Within OMS, only a limited number of investigations have specifically evaluated the impact of midazolam on recovery room LOS after outpatient anesthesia. 10,11 Smiley and Prior 10 performed a prospective randomized trial comparing 2 sedation protocols for patients 18 to 32 years old undergoing outpatient third molar surgery. Twenty-four patients were randomized to receive a continuous infusion of dexmedetomidine alone or a continuous infusion of dexmedetomidine combined with a 0.03-mg/kg dose of midazolam.…”

“…1,3,6,[8][9][10][12][13][14][15][16][17] Multiple investigators have reported transient cognitive impairment after administration of midazolam in different clinical settings, including gastrointestinal endoscopy, 1,12,13,17 pediatric anesthesia, 6,14-16 and outpatient OMS. 3,10,11 However, most of these studies used various psychomotor assessments as their primary outcome measurement and did not specifically assess recovery room LOS, as was performed in the present study. Within OMS, only a limited number of investigations have specifically evaluated the impact of midazolam on recovery room LOS after outpatient anesthesia.…”

“…6,8,9 Recently, some evidence has suggested that IV midazolam might be associated with prolonged recovery time when administered for outpatient anesthesia for various oral surgical procedures. 10,11 In addition, unpublished data from the Department of Anesthesiology at the Mayo Clinic (Rochester, MN) have identified midazolam administration as an independent risk factor for prolonged stay in the postanesthesia care unit after general anesthesia for different surgical procedures, including OMS. The extremely robust outpatient sedation practice at the authors' institution provided a unique opportunity to evaluate the effects of midazolam on a very large number of patients undergoing IV sedation for outpatient third molar surgery.…”

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

“…Furthermore, intravenous sedation using dexmedetomidine alone was reported to be insufficient for amnesia during dental surgery. 22 These findings might suggest that dental surgical procedures require a larger amount of sedatives to maintain adequate sedation levels.…”