An interesting article titled “Sedation Protocol Using Dexmedetomidine for Third Molar Extraction” appears in the 2016 Journal of Oral and Maxilofacial Surgery written by Dae-Seung Ryu and et. al. (vol. 74, pp. 926.e1-926.e7). The article seems to determine a sedation protocol for dexmedetomidine.
The authors state that IV sedation is often given in cases of wisdom teeth surgery with midazolam being a medication commonly used. When midazolam is combined with opioids it can cause respiratory depression. Dexmedetomidine is an alpa2-agonist acting on adrenoceptors in many tissues, including those in the nervous, cardiovascular, and respiratory systems. Compared with midazolam, the major advantage of dexmedetomidine is its minimal effect on the respiratory system. It also produces an analgesic effect which can help alleviate the sensation of pain after tooth extraction.
The authors set out to study the pain, patient satisfaction, sedation depth, and adverse effects after wisdom teeth extraction using dexmedetomidine and to compare IV and intranasal (IN) routes of administration. The patients included in the study were in Seoul Korea. They were required to have ipsilateral upper and lower third molars. The upper molar had to be a routine extraction and the lower molar had to be a surgical extraction. A total of 240 patients were randomly assigned to one of three groups. In group 1 wisdom teeth extractions were performed under local anesthesia only. In group 2 wisdom teeth were extracted after IV sedation with dexmedetomidine and local anesthesia. In group 3 wisdom teeth were extracted after IN sedation with dexmedetomidine and local anesthesia. The dose of dexmedetomidine in group 2 was 1.00 mg/kg and that in group 3 was 1.50 mg/kg.
Patients were found to be more satisfied and had less pain the the two dexmedetomidine groups but there was no statistical difference between these two groups. There were no adverse events reported in any of the patients. The sedation was found to be slightly more using IV sedation versus IN sedation for dexmedetomidine but it was not statistically meaningful. The authors did also find that those patients receiving dexmedetomidine reported decreased pain extending from the immediate postoperative period for three days. It should be noted that the sedation protocol for dexmedetomidine used took 3 hours per patient which is not very suitable for busy oral surgeons offices.