2018 Volume 46 Issue 4 Pages 164-166
The primary clinical features of osteogenesis imperfecta (OI) include a low bone mass and high bone fragility, which increases vulnerability to bone fractures. We performed a dental treatment under general anesthesia in a pediatric patient with OI. The patient was a 4-year-old boy (weight, 7.3 kg) who had already had five bone fractures. He received an intranasal administration of 14.6 μg (2.0 μg/kg) of dexmedetomidine (DEX) 30 min prior to the general anesthesia to prevent bone fractures caused by restraint during the induction of anesthesia. The anesthesia was successfully induced with nitrous oxide, oxygen, and sevoflurane in a safe and uncomplicated manner, and adequate sedation was achieved (Ramsay Sedation Scale, 5). After orotracheal intubation, the anesthesia was maintained with remifentanil and sevoflurane in air and oxygen. To prevent agitation upon emergence from the general anesthesia, a continuous infusion of 0.4 μg/kg/h of DEX had been administered from the start of the dental treatment, and this administration was continued until 5 min after the removal of the tracheal tube. No abnormalities or fractures were observed after surgery, and the patient was discharged on the following day. This case suggests that the presurgical administration of intranasal DEX provides adequate preoperative sedation for patients with OI without causing stress or respiratory depression.
