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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

Summary of the therapeutic procedure. 1⃞: Extraction of the left maxillary lateral second molar and cyst enucleation. 2⃞: Extraction of the left maxillary central incisor and lateral incisor and cyst enucleation. 3⃞: Extraction of the left mandibular first and second molars. 4⃞: Extraction of the right mandibular third molar. Observer's assessment of alertness/sedation (OAA/S) scale: Score level 5=responds readily to name spoken in normal tone, score level 4=lethargic response to name spoken in normal tone, score level 3=responds only after name is called loudly and/or repeatedly, score level 2=responds only after mild prodding or shaking, score level 1=does not respond to mild prodding or shaking. × to ×: sedative duration, ㉧ to ㉧: operative duration.
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Figure 3: Summary of the therapeutic procedure. 1⃞: Extraction of the left maxillary lateral second molar and cyst enucleation. 2⃞: Extraction of the left maxillary central incisor and lateral incisor and cyst enucleation. 3⃞: Extraction of the left mandibular first and second molars. 4⃞: Extraction of the right mandibular third molar. Observer's assessment of alertness/sedation (OAA/S) scale: Score level 5=responds readily to name spoken in normal tone, score level 4=lethargic response to name spoken in normal tone, score level 3=responds only after name is called loudly and/or repeatedly, score level 2=responds only after mild prodding or shaking, score level 1=does not respond to mild prodding or shaking. × to ×: sedative duration, ㉧ to ㉧: operative duration.

Mentions: The patient was at increased risk of developing severe complications of aortic aneurysm such as cardiac failure and rupture of the aorta through a sudden increase in blood pressure 12.(Fig. 2) The use of intravenous sedation was deemed appropriate to avoid sudden changes in blood pressure and to stabilize the patient's hemodynamics. The patient's respiratory depression due to morbid obesity also required attention. Accordingly, we planned to use DEX4, which is reported to cause mild respiratory depression, for sedation. The surgery and sedation procedure were explained to the patient, and informed consent was obtained. The surgery involved three oral surgeons, one board-certified dental anesthesiologist, and one nurse. The patient was required to fast for six hours before the procedure. We adopted Fowler's position during the surgery, and vital signs (peripheral capillary oxygen saturation, heart rate, blood pressure, and electrocardiogram) were continuously monitored. Oxygen was administered at 3 L/min through a nasal cannula. An initial loading dose of DEX was administered at 4.4 µg/kg/hr for 10 minutes, followed by continuous infusion at 0.075 to 0.3 µg/kg/hr. The procedure took 1 hour 27 minutes to complete, with stable hemodynamics throughout and no marked changes, even during local anesthesia with 2% lidocaine and 1:80,000 epinephrine.(Fig. 3) Surgery was safely completed without any complications. For postoperative analgesia, oral celecoxib 400 mg/day was administered until 24 hours after surgery. Thereafter, acetaminophen 3,000 mg/day and loxoprofen sodium hydrate 60 mg were administered as rescue analgesics. Postoperative hemostasis was satisfactory, and no perioperative complications were observed.


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)

Summary of the therapeutic procedure. 1⃞: Extraction of the left maxillary lateral second molar and cyst enucleation. 2⃞: Extraction of the left maxillary central incisor and lateral incisor and cyst enucleation. 3⃞: Extraction of the left mandibular first and second molars. 4⃞: Extraction of the right mandibular third molar. Observer's assessment of alertness/sedation (OAA/S) scale: Score level 5=responds readily to name spoken in normal tone, score level 4=lethargic response to name spoken in normal tone, score level 3=responds only after name is called loudly and/or repeatedly, score level 2=responds only after mild prodding or shaking, score level 1=does not respond to mild prodding or shaking. × to ×: sedative duration, ㉧ to ㉧: operative duration.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Summary of the therapeutic procedure. 1⃞: Extraction of the left maxillary lateral second molar and cyst enucleation. 2⃞: Extraction of the left maxillary central incisor and lateral incisor and cyst enucleation. 3⃞: Extraction of the left mandibular first and second molars. 4⃞: Extraction of the right mandibular third molar. Observer's assessment of alertness/sedation (OAA/S) scale: Score level 5=responds readily to name spoken in normal tone, score level 4=lethargic response to name spoken in normal tone, score level 3=responds only after name is called loudly and/or repeatedly, score level 2=responds only after mild prodding or shaking, score level 1=does not respond to mild prodding or shaking. × to ×: sedative duration, ㉧ to ㉧: operative duration.
Mentions: The patient was at increased risk of developing severe complications of aortic aneurysm such as cardiac failure and rupture of the aorta through a sudden increase in blood pressure 12.(Fig. 2) The use of intravenous sedation was deemed appropriate to avoid sudden changes in blood pressure and to stabilize the patient's hemodynamics. The patient's respiratory depression due to morbid obesity also required attention. Accordingly, we planned to use DEX4, which is reported to cause mild respiratory depression, for sedation. The surgery and sedation procedure were explained to the patient, and informed consent was obtained. The surgery involved three oral surgeons, one board-certified dental anesthesiologist, and one nurse. The patient was required to fast for six hours before the procedure. We adopted Fowler's position during the surgery, and vital signs (peripheral capillary oxygen saturation, heart rate, blood pressure, and electrocardiogram) were continuously monitored. Oxygen was administered at 3 L/min through a nasal cannula. An initial loading dose of DEX was administered at 4.4 µg/kg/hr for 10 minutes, followed by continuous infusion at 0.075 to 0.3 µg/kg/hr. The procedure took 1 hour 27 minutes to complete, with stable hemodynamics throughout and no marked changes, even during local anesthesia with 2% lidocaine and 1:80,000 epinephrine.(Fig. 3) Surgery was safely completed without any complications. For postoperative analgesia, oral celecoxib 400 mg/day was administered until 24 hours after surgery. Thereafter, acetaminophen 3,000 mg/day and loxoprofen sodium hydrate 60 mg were administered as rescue analgesics. Postoperative hemostasis was satisfactory, and no perioperative complications were observed.

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