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Oral surgery under local anesthesia with dexmedetomidine sedation in a morbidly obese patient with aortic dissection.

Seto M, Matsuda M, Narihira K, Kikuta T - J Korean Assoc Oral Maxillofac Surg (2016)

Bottom Line: Our patient was at a high risk of aortic rupture caused by hypertension and breathing difficulty in the supine position.Dexmedetomidine (DEX) is an anti-anxiety, sedative, and analgesic medicine that can stabilize circulatory dynamics and minimize blood pressure fluctuations.In conclusion, our understanding of the risk factors of DEX enabled us to perform safe invasive oral treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.

ABSTRACT
We report a case of a morbidly obese man with an aortic aneurysm, in whom dental surgery was performed before elective cardiac surgery. His aortic aneurysm required emergency surgery. However, because of his morbid obesity, elective cardiac surgery was planned. Considering the high risk of infective endocarditis, dental surgery was required. Our patient was at a high risk of aortic rupture caused by hypertension and breathing difficulty in the supine position. Dexmedetomidine (DEX) is an anti-anxiety, sedative, and analgesic medicine that can stabilize circulatory dynamics and minimize blood pressure fluctuations. We administered intravenous DEX for sedation of the patient in Fowler's position. In conclusion, our understanding of the risk factors of DEX enabled us to perform safe invasive oral treatment.

No MeSH data available.


Related in: MedlinePlus

Imaging findings. A. Original panoramic X-ray findings. Periapical lesions are observed in the apical area of the right mandibular third molar, left mandibular first and second molars, and left maxillary central incisor. B. Computed tomography findings (sagittal section image). Cyst-like images are observed in the apical area of the left maxillary lateral incisor and second molar.
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Figure 1: Imaging findings. A. Original panoramic X-ray findings. Periapical lesions are observed in the apical area of the right mandibular third molar, left mandibular first and second molars, and left maxillary central incisor. B. Computed tomography findings (sagittal section image). Cyst-like images are observed in the apical area of the left maxillary lateral incisor and second molar.

Mentions: A 45-year-old morbidly obese man was transported by ambulance to the Emergency Medical Care Center at Fukuoka University Hospital (Fukuoka, Japan) with suspected acute heart failure after developing a sudden difficulty in breathing with pink frothy sputum. According to his wife, the patient had no significant medical history other than hypertension. Detailed examination revealed an aortic aneurysm (Stanford types A and B), aortic regurgitation, aortic valve ring ectasia, ascending thoracic aorta aneurysm, hypertension, paroxysmal tachycardia, atrial fibrillation, primary lung cancer in the left lower lobe, and morbid obesity (weight, 124 kg; height, 170 cm; body mass index [BMI], 42.9 kg/m2). The aortic aneurysm required emergency surgery. However, because of the patient's morbid obesity, elective vascular graft replacement of the thoracic ascending aorta, aortic valve replacement, pulmonary vein isolation surgery, and segmental left lower lobe resection were planned after gradual weight reduction with dietary therapy. On hospital day 16, the patient underwent a preoperative detailed intraoral examination in our department. At the patient's first visit to our department, his weight was 109 kg (BMI, 37.7 kg/m2). Intraoral examination revealed six teeth with periapical lesions and two pigeon eggsized radicular cysts that could become potential sources of infection after surgery.(Fig. 1)


Oral surgery under local anesthesia with dexmedetomidine sedation in a morbidly obese patient with aortic dissection.

Seto M, Matsuda M, Narihira K, Kikuta T - J Korean Assoc Oral Maxillofac Surg (2016)

Imaging findings. A. Original panoramic X-ray findings. Periapical lesions are observed in the apical area of the right mandibular third molar, left mandibular first and second molars, and left maxillary central incisor. B. Computed tomography findings (sagittal section image). Cyst-like images are observed in the apical area of the left maxillary lateral incisor and second molar.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940202&req=5

Figure 1: Imaging findings. A. Original panoramic X-ray findings. Periapical lesions are observed in the apical area of the right mandibular third molar, left mandibular first and second molars, and left maxillary central incisor. B. Computed tomography findings (sagittal section image). Cyst-like images are observed in the apical area of the left maxillary lateral incisor and second molar.
Mentions: A 45-year-old morbidly obese man was transported by ambulance to the Emergency Medical Care Center at Fukuoka University Hospital (Fukuoka, Japan) with suspected acute heart failure after developing a sudden difficulty in breathing with pink frothy sputum. According to his wife, the patient had no significant medical history other than hypertension. Detailed examination revealed an aortic aneurysm (Stanford types A and B), aortic regurgitation, aortic valve ring ectasia, ascending thoracic aorta aneurysm, hypertension, paroxysmal tachycardia, atrial fibrillation, primary lung cancer in the left lower lobe, and morbid obesity (weight, 124 kg; height, 170 cm; body mass index [BMI], 42.9 kg/m2). The aortic aneurysm required emergency surgery. However, because of the patient's morbid obesity, elective vascular graft replacement of the thoracic ascending aorta, aortic valve replacement, pulmonary vein isolation surgery, and segmental left lower lobe resection were planned after gradual weight reduction with dietary therapy. On hospital day 16, the patient underwent a preoperative detailed intraoral examination in our department. At the patient's first visit to our department, his weight was 109 kg (BMI, 37.7 kg/m2). Intraoral examination revealed six teeth with periapical lesions and two pigeon eggsized radicular cysts that could become potential sources of infection after surgery.(Fig. 1)

Bottom Line: Our patient was at a high risk of aortic rupture caused by hypertension and breathing difficulty in the supine position.Dexmedetomidine (DEX) is an anti-anxiety, sedative, and analgesic medicine that can stabilize circulatory dynamics and minimize blood pressure fluctuations.In conclusion, our understanding of the risk factors of DEX enabled us to perform safe invasive oral treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.

ABSTRACT
We report a case of a morbidly obese man with an aortic aneurysm, in whom dental surgery was performed before elective cardiac surgery. His aortic aneurysm required emergency surgery. However, because of his morbid obesity, elective cardiac surgery was planned. Considering the high risk of infective endocarditis, dental surgery was required. Our patient was at a high risk of aortic rupture caused by hypertension and breathing difficulty in the supine position. Dexmedetomidine (DEX) is an anti-anxiety, sedative, and analgesic medicine that can stabilize circulatory dynamics and minimize blood pressure fluctuations. We administered intravenous DEX for sedation of the patient in Fowler's position. In conclusion, our understanding of the risk factors of DEX enabled us to perform safe invasive oral treatment.

No MeSH data available.


Related in: MedlinePlus