Intravenous Sedation with Propofol Might Increase the Gag Reflex Threshold : A Case Report

Abstract

  The gag reflex not only interferes with dental treatment, but also decreases quality of life in patients who have difficulty brushing their teeth or using dentures. We treated a case in which intravenous sedation with propofol was used in a patient with a severe gag reflex ; as a result of the dentures being made while using the lightest level of sedation that would not permit a gag reflex, the patient was able to wear the dentures for short periods of time.

  The patient was a 64-year-old woman with a pretreatment gagging severity index of grade Ⅴ (most severe) ; psychological factors were strongly involved. Intravenous sedation was performed with conscious sedation, and the sedation level was adjusted while confirming with the patient as to whether treatment was possible. As a result, the Ce (estimated effect-site concentration) of treatable propofol decreased with repeated intravenous sedation. This finding suggested a gradual increase in the threshold at which the gag reflex appeared. Intravenous sedation with propofol may enable efficient desensitization. The repetition of sedation within a short period of time might also have had an additive effect.