Remifentanil and Dexmedetomidine Sedation for Office Oral Surgery Patients - Abstract
Background: Our sedation service for an Oral maxillo facial surgeon was affected due to widespread drug shortages for regular sedation medications, fentanyl and midazolam, were not available for deep sedation. Procedural sedation was instead provided with dexmedetomidine (DEX) and remifentanil (REMI) along with propofol (PROP) supplementation as needed, in an outpatient oral surgery office.
Methods: After IRB approval a retrospective chart review was performed. The sedation regimen involved REMI at an infusion rate of 0.2 mcg/kg/minute with a loading dose of DEX, 0.7 mcg/kg. After 11 patients the starting REMI infusion rate was reduced to 0.1 mcg/kg/min. PROP boluses, were then administered starting 5 minutes after the DEX load had completed, the delay allowing time for the slower onset of DEX. A bispectral index (BIS) monitor was used when available. Statistical analysis was done using t-test, one-way ANOVA, Kruskal Wallis and Mann Whitney U tests.
Results: A total of 65 charts were reviewed. The mean dose of DEX was 0.7 mcg/kg and loading took 6 minutes. The mean number of supplemental PROP doses was 6, Patients were ready for discharge within 30 minutes. Average BIS reading during the procedure was 70, consistent with deep sedation. Higher than anticipated episodes of apnea, hypoxemia prompted the use of lower starting dose of REMI infusion.
Conclusions: A sedation regimen using DEX, REMI with PROP supplementation is safe for short term sedation and analgesia. The quick discharge times make it an attractive regimen to facilitate the quick disposition of patients from procedural sedation.