2021 Volume 49 Issue 2 Pages 49-51
Maintaining an optimal level of sedation can be difficult in patients with dental phobia depending on the level of fear, degree of pain, and the presence of limitations on the selection of sedatives for intravenous sedation. We report a case in which a combination of midazolam (MDZ), dexmedetomidine (DEX), and fentanyl (Fent) was successfully used in a patient in whom previous intravenous sedation using MDZ alone had been difficult. The patient was a 32-year-old woman (height, 159.5 cm ; weight, 43.7 kg) who had anxiety disorder and was receiving tofisopam and tandospirone citrate. Intravenous sedation was indicated for the extraction of impacted wisdom teeth, since she had a strong fear of undergoing dental treatment. However, propofol was contraindicated because of a suspected soybean allergy. During the first phase of intravenous sedation performed using only MDZ, hyperventilation occurred 4 times because of pain stimulation, and the additional administration of MDZ (4 mg) was required to diminish the hyperventilation. After local anesthesia was successfully achieved, management became difficult due to respiratory depression and glossoptosis, requiring a reduction in the extent of the surgery. With this background in mind, stable management was achieved during the second phase of management by the continuous intravenous infusion of DEX (0.4-0.5 μg/kg/h) after MDZ (3 mg) ; 4 boluses of Fent (25 μg) were also administered because of the highly invasive nature of the surgery. This intravenous sedation using a combination of three drugs seemed to provide a sufficient sedation level and pain control, reducing intraoperative hyperventilation and the potential adverse effects of the drugs being used. This method may be an effective option for intravenous sedation in patients with dental phobia in whom propofol is contraindicated.
