title: Dexmedetomidine, ketamine, and midazolam for oral rehabilitation: a case report.
abstract: Intravenous sedation is frequently provided by anesthesiologists for phobic patients undergoing elective dental treatment in outpatient settings. Propofol is one of the most commonly used anesthetic agents that can result in apnea and respiratory depression, thereby posing potential difficulties with perioperative airway management. Dexmedetomidine has been utilized successfully in intravenous sedation for a wide variety of procedures and holds potential as an alternative to propofol in outpatient dental settings. However, as a single agent, it may not provide adequate depth of sedation and analgesia for oral rehabilitation. In this case report we demonstrate an effective alternative intravenous deep-sedation technique for an adult phobic patient undergoing oral rehabilitation utilizing 3 agents in combination: dexmedetomidine, ketamine, and midazolam. This combination of agents may be especially useful for those patients with a history of substance abuse, where administration of opioids may be undesirable or contraindicated.
authors: Chief Resident, Dental Anesthesiology Residency Program, and.
authors: Bill W S
authors: BW
authors: Kim
authors: Robert M
authors: RM
authors: Peskin
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects; D000766:Anesthesia, Dental / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000778:Anesthetics, Dissociative / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D054810:Deep Sedation / Q000379:methods*; D016854:Dental Anxiety / Q000517:prevention & control; D017742:Dental Care for Chronically Ill; D003731:Dental Caries / Q000628:therapy*; D003793:Dental Restoration, Permanent / Q000379:methods; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007649:Ketamine / Q000008:administration & dosage*; D008874:Midazolam / Q000008:administration & dosage*; D009293:Opioid-Related Disorders; D010098:Oxycodone / Q000009:adverse effects; D014081:Tooth Extraction / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D007649:Ketamine; D010098:Oxycodone; D008874:Midazolam
keywords: Dentistry; Intravenous deep sedation; Ketamine; Midazolam; Outpatient anesthesia