Prolonged Recovery Associated With Dexmedetomidine When Used as a Sole Sedative Agent in Office-Based Oral and Maxillofacial Surgery Procedures

Laila Makary, Vadim Vornik, Richard Finn, Fima Lenkovsky, Allan L. McClelland, Jeremy Thurmon, Brian Robertson

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Purpose: Office-based oral and maxillofacial surgical procedures that require sedation are popular. Dexmedetomidine has the advantages of having a minimal effect on respiration and an antisialogogue effect that could make it a good choice for dental procedures. Materials and Methods: We performed a prospective pilot study in which patients undergoing office-based oral and maxillofacial surgical procedures received dexmedetomidine as a sole sedative agent. The loading dose of dexmedetomidine (1 μg/kg infused over 10 minutes) was followed by a maintenance dose (0.2 to 0.8 μg/kg/hour) to achieve a Ramsay sedation score of 2 to 3. The demographic data were collected, and the pre- and intraprocedural vital signs and Ramsay sedation score were recorded every 5 minutes. The duration of the procedure, recovery time, and patient and surgeon satisfaction were documented. Results: No statistically significant changes were found in the heart rate, respiratory rate, or oxygen saturation during the procedure when compared to baseline. However, we noticed a significant decrease in the heart rate at the end of the loading dose, and statistically significant change in the blood pressure between baseline and during the procedure (P < .05). The initial local anesthetic injections were recalled by 26% of the patients, and 73% had some recollection of the procedure. Nevertheless, the patient satisfaction score (range 1 to 10) was 8.6 ± 2.3, and 86% of the patients would recommend this type of sedation. The surgeon satisfaction score (range, 1 to 5) was 3.9 ± 1.3. The recovery time was prolonged (82.2 ± 24.3 minutes) when compared with the total procedure time (44.6 ± 27.9 minutes). Conclusions: Dexmedetomidine has demonstrated hemodynamic and respiratory stability when used as a sole sedative agent. Despite the discomfort on injection and the lack of reliable amnesic property, patient and surgeon satisfaction were high. However, the prolonged recovery time makes this drug unsuitable for busy office-based practices. We believe it should be reserved for patients with a high risk of respiratory complications (eg, obese patients or those with a history of sleep apnea).

Original languageEnglish (US)
Pages (from-to)386-391
Number of pages6
JournalJournal of Oral and Maxillofacial Surgery
Volume68
Issue number2
DOIs
StatePublished - Feb 2010

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Oral Surgical Procedures
Dexmedetomidine
Oral Surgery
Hypnotics and Sedatives
Patient Satisfaction
Heart Rate
Injections
Vital Signs
Sleep Apnea Syndromes
Respiratory Rate
Local Anesthetics
Tooth
Respiration
Hemodynamics
Demography
Prospective Studies
Oxygen
Blood Pressure

ASJC Scopus subject areas

  • Oral Surgery
  • Otorhinolaryngology
  • Surgery

Cite this

Prolonged Recovery Associated With Dexmedetomidine When Used as a Sole Sedative Agent in Office-Based Oral and Maxillofacial Surgery Procedures. / Makary, Laila; Vornik, Vadim; Finn, Richard; Lenkovsky, Fima; McClelland, Allan L.; Thurmon, Jeremy; Robertson, Brian.

In: Journal of Oral and Maxillofacial Surgery, Vol. 68, No. 2, 02.2010, p. 386-391.

Research output: Contribution to journalArticle

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AU - Vornik, Vadim

AU - Finn, Richard

AU - Lenkovsky, Fima

AU - McClelland, Allan L.

AU - Thurmon, Jeremy

AU - Robertson, Brian

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N2 - Purpose: Office-based oral and maxillofacial surgical procedures that require sedation are popular. Dexmedetomidine has the advantages of having a minimal effect on respiration and an antisialogogue effect that could make it a good choice for dental procedures. Materials and Methods: We performed a prospective pilot study in which patients undergoing office-based oral and maxillofacial surgical procedures received dexmedetomidine as a sole sedative agent. The loading dose of dexmedetomidine (1 μg/kg infused over 10 minutes) was followed by a maintenance dose (0.2 to 0.8 μg/kg/hour) to achieve a Ramsay sedation score of 2 to 3. The demographic data were collected, and the pre- and intraprocedural vital signs and Ramsay sedation score were recorded every 5 minutes. The duration of the procedure, recovery time, and patient and surgeon satisfaction were documented. Results: No statistically significant changes were found in the heart rate, respiratory rate, or oxygen saturation during the procedure when compared to baseline. However, we noticed a significant decrease in the heart rate at the end of the loading dose, and statistically significant change in the blood pressure between baseline and during the procedure (P < .05). The initial local anesthetic injections were recalled by 26% of the patients, and 73% had some recollection of the procedure. Nevertheless, the patient satisfaction score (range 1 to 10) was 8.6 ± 2.3, and 86% of the patients would recommend this type of sedation. The surgeon satisfaction score (range, 1 to 5) was 3.9 ± 1.3. The recovery time was prolonged (82.2 ± 24.3 minutes) when compared with the total procedure time (44.6 ± 27.9 minutes). Conclusions: Dexmedetomidine has demonstrated hemodynamic and respiratory stability when used as a sole sedative agent. Despite the discomfort on injection and the lack of reliable amnesic property, patient and surgeon satisfaction were high. However, the prolonged recovery time makes this drug unsuitable for busy office-based practices. We believe it should be reserved for patients with a high risk of respiratory complications (eg, obese patients or those with a history of sleep apnea).

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