title: Prolonged recovery associated with dexmedetomidine when used as a sole sedative agent in office-based oral and maxillofacial surgery procedures.
abstract: OBJECTIVE
  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.
  
  
  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 microg/kg infused over 10 minutes) was followed by a maintenance dose (0.2 to 0.8 microg/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).
authors.affiliation: University of Texas Southwestern Medical Center, Dallas Veterans Affairs Medical Center, North Texas North Texas Health Care System, Dallas, TX, USA.
authors.forename: Laila
authors.initials: L
authors.lastname: Makary
authors.forename: Vadim
authors.initials: V
authors.lastname: Vornik
authors.forename: Richard
authors.initials: R
authors.lastname: Finn
authors.forename: Fima
authors.initials: F
authors.lastname: Lenkovsky
authors.forename: Allan L
authors.initials: AL
authors.lastname: McClelland
authors.forename: Jeremy
authors.initials: J
authors.lastname: Thurmon
authors.forename: Brian
authors.initials: B
authors.lastname: Robertson
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation / Q000379:methods*; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology; D007267:Injections; D008297:Male; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D014081:Tooth Extraction
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine