Abstract
This report describes an adult patient with mental retardation and congenital heart disease who underwent a tooth extraction under intravenous sedation. The patient, an 18-year-old female, visited our hospital to undergo an orthodontics-related tooth extractions. She had been diagnosed as having tetralogy of Fallot soon after her birth and had undergone several surgical treatments including bidirectional Glenn procedures and a Fontan procedure, etc., for the treatment of corrected transposition of great arteries, ventricular septal defects, and pulmonary atresia prior to the age of 11 years. She had been cooperative with the treatments despite her mental retardation. She frequently had episodes of hypoxia caused by crying spells during her everyday life. She had undergone the extraction of bilateral upper first premolars and the right lower first premolar under local anesthesia but had cried excessively during the treatment. As a result, her Spo2 had decreased markedly. The left lower first premolar was completely impacted and required extraction under intravenous sedation to reduce the invasiveness and to alleviate the patient’s physical and mental stress. Despite the fact that a Fontan circulation had been established, her daily Spo2 was relatively low because of veno-venous collateral circulation and a persistent left superior vena cava. Episodes of hypoxia triggered by a low pulmonary blood flow caused by an increase in pulmonary vascular resistance or a decrease in systemic vascular resistance were thus a concern. Midazolam and pentazocine was administered at the start of sedation. Propofol was administered during the operation.
In cases such as this one, episodes of hypoxia should be prevented. Intravenous sedation was found to be effective for maintaining an optimal hemodynamic condition, as it enabled increases in the central venous pressure to be avoided, compared with general anesthesia. Intravenous sedation also reduced anesthetics-induced vasodilatation and did not stimulate the sympathetic nervous system due to a need for intubation and extubation.
