Deep Sedation with Dexmedetomidine and Propofol for Oral Surgery: A Retrospective Study - Abstract
Introduction: Propofol is frequently used as part of a deep IV sedation regimen for third molar extractions. Our clinic experienced severe drug shortages during 2012-2013 resulting in the use of alternative sedation plans. This review reports the use of IV dexmedetomidine load dose, using multiple small boluses as an alternative to propofol in conjunction with midazolam and fentanyl. The quality of sedation and need for additional propofol was evaluated.
Methods: After Investigational Review Board (IRB) approval we performed a retrospective review of our QA database with respect to this sedation technique. Data collection included patient demographics, drug dosing, cardio-respiratory parameters, sedation assessment and complications. Dexmedetomidine (0.7 mcg/kg) was administered as 4 boluses, along with 2 doses of 2 mg midazolam and 1 dose of 100 mcg fentanyl. After a 6-minute pause to allow adequate time for dexmedetomidine onset the procedure was started and adjunct propofol 10 mg increments were used if needed.
Results: The charts of 70 patients were reviewed, mean age of 17.7 years. In 46% of the patient’s deep sedation was satisfactorily provided without the need for propofol. The mean BIS score of 65 was no different to those patients who required propofol for satisfactory sedation. The discharge times for those patients who did or did not receive propofol was not different. The incidence of airway complications was no lower in the dexmedetomidine only group.