Fibromyalgia syndrome (FMS) is characterized by chronic widespread dysfunctional pain in specific regions. Although intravenous sedation (IVS) is often required for dental procedures in patients with FMS, pain attacks sometimes occur during the perioperative period. We report a case in which a patient with FMS underwent two third-molar-extraction procedures under IVS. A 22-year-old woman with mild FMS was scheduled to undergo right-upper- and right-lower-third-molar extractions under IVS. Sedation was induced with 2 mg of midazolam and 20 mg of propofol. Subsequently, the continuous administration of propofol was initiated at a rate of 2 mg/kg/h. After infiltrative anesthesia was performed using 2% lidocaine with 1 : 80,000 adrenaline, the tooth-extraction procedure was started. During mandibular drilling, she experienced pain and began to hyperventilate. Following the immediate administration of 40 mg of propofol and 1 mg of midazolam, the rate of propofol administration was increased to 5 mg/kg/h and her hyperventilation disappeared. Although the tooth extractions were accomplished without subsequent pain, systemic pain attacks occurred for a week after the surgery. After two years, she was once more scheduled to undergo left-upper- and left-lower-third-molar extractions under IVS. Sedation was induced with 2 mg of midazolam, and the continuous administration of propofol was initiated at a rate of 5 mg/kg/h. Not only infiltrative anesthesia, but also a left-inferior alveolar nerve block was performed before the start of the tooth extractions. She did not complain of systemic pain during or after the surgery. Even in patients with mild FMS, sufficient local anesthesia and sedation levels are required during dental procedures under IVS to prevent pain attacks throughout the perioperative period.
