Dexmedetomidine-midazolam sedation reduces unexpected patient movement during dental surgery as compared with propofol-midazolam sedation.

Publication date: Available online 10 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Eriko Togawa, Hiroshi Hanamoto, Hiroharu Maegawa, Chizuko Yokoe, Hitoshi Niwa

Abstract

Purpose

Due to its unpredictability, unexpected patient movement is one of the most important problems during surgery while under monitored anesthesia care with sedation. The purpose of this study was to compare unexpected patient movement during dental surgery while under dexmedetomidine and propofol sedation.

Methods

We designed and implemented a prospective, randomized, controlled trial. Patients undergoing dental surgery requiring intravenous sedation were randomly assigned to dexmedetomidine-midazolam (dexmedetomidine group) or propofol-midazolam (propofol group) sedation groups. In each group, 0.02 mg/kg of midazolam was administered in conjunction with continuous administration of dexmedetomidine or propofol in order to maintain a bispectral index value of 70-80. Unexpected patient movement interfering with the procedure was defined as: acceptable, no body movement or only one controllable movement; or as unacceptable, two or more controllable movements or any uncontrollable movement. The primary outcome was unexpected patient movement, with the secondary outcome defined as snoring and cough reflex. Other variables included the demographic and procedural characteristics. Continuous or ordinal variables were analyzed using a Student's t-test or a Mann-Whitney test. Dichotomous or categorical variables were analyzed using a χ² test or a Fisher's exact test. A P value < 0.05 was considered to indicate statistical significance.

Results

The 88 patients enrolled in the study were grouped as follows: dexmedetomidine group (n = 44) and propofol group (n = 44). There were no significant differences between the groups for the demographics and baseline variables. Intraoperative unacceptable patient movement occurred more commonly in the propofol (n = 13, 30%) vs. dexmedetomidine group (n = 4, 9%), P = 0.015. Intraoperative snoring occurred more commonly in the dexmedetomidine vs. propofol group (P = 0.045). Incidence and number of cough reflexes were comparable between the groups.

Conclusion

Dexmedetomidine-midazolam sedation reduces unexpected patient movement during dental surgery as compared with propofol-midazolam sedation.

https://ift.tt/2NFN0O9