Dexmedetomidine versus midazolam in outpatient third molar surgery.
OBJECTIVE
The aim of this study was to compare the use of dexmedetomidine with the use of midazolam during intravenous conscious sedation in third molar surgery.


METHODS
Twenty healthy patients with symmetrically impacted mandibular third molars were included in this double-blind, crossover, randomized study. Either dexmedetomidine (group D) (4 microg.kg(-1).h(-1)) or midazolam (group M) (0.4 mg.kg(-1).h(-1)) was administered intravenously for 15 minutes before the first operation. At the second operation, the other agent was applied. Cardiorespiratory data were collected. The intraoperative sedation level, patient cooperation, and postoperative performance were scored and any pain reaction during the local anesthetic injection was recorded. Visual analog scales were additionally used for the subjective assessment of pain and patient satisfaction. Amnesia was evaluated by the patients' ability to recall the objects shown during the operations and the local anesthetic injection. Patients' preferences were recorded during the interview at the end of the second operations.


RESULTS
The mean heart rate and blood pressure measurements were significantly lower in group D. There was no significant difference in the respiratory findings. A significantly higher number of patients showed pain reactions in group M. Sedation level, postoperative performance, and VAS pain scores were not statistically significant, whereas the differences in cooperation score and VAS for patient satisfaction were significant. Adequate amnesia was obtained in group M, however, no amnesia was demonstrated in group D. Sixty-five percent of the patients indicated a preference for dexmedetomidine sedation.


CONCLUSIONS
Dexmedetomidine may be a remarkable alternative to midazolam for intravenous sedation because it seems to be a reliable and safe method, with additional analgesic effect providing a satisfactory sedation level without any serious side effects during impacted third molar surgery.
Ustün
Yakup
Y
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cukurova University, Adana, Turkey. yustun@cu.edu.tr
Gündüz
Murat
M
Erdoğan
Ozgür
O
Benlidayi
M Emre
ME
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation; D003299:Cooperative Behavior; D018592:Cross-Over Studies; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004311:Double-Blind Method; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007275:Injections, Intravenous / Q000009:adverse effects; D008568:Memory / Q000187:drug effects; D008874:Midazolam / Q000008:administration & dosage*; D008964:Molar, Third / Q000601:surgery*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects; D014081:Tooth Extraction; D014095:Tooth, Impacted / Q000601:surgery*
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam