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Safety and Efficacy of IV Dexmedetomidine as an Adjunct to Propofol to Sedate Anxious and Uncooperative Pediatric Dental Patients: A Randomized Controlled Trial
1Department of Pedodontics and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
2Unit of Pedodontics and Preventive Dentistry, PGIMER, Chandigarh, India
3Department of Anaesthesia and Intensive Care Medicine, PGIMER, Chandigarh, India
*Corresponding Author(s): Ferah Rehman E-mail: drferahrehman@gmail.com
Objective: To evaluate the safety and efficacy of dexmedetomidine (dex) as an adjunct to propofol sedation in pediatric dental patients. Study design: This RCT enrolled 30 anxious ASA-I 2-5 year olds. Allocated into 2 groups either receiving IV propofol (1 mg/kg)(Gp-P) or [IV dex (1ug/kg) with propofol(1 mg/kg)] (Gp-D) after oral midazolam premedication (0.5 mg/kg). Sedation maintained with propofol infusion at 50–75ug/kg/min. Additional bolus/es of propofol (1mg/kg) was/were administered in case of inadequate sedation. Primary outcome was to compare requirement of propofol in two groups. Secondary outcomes were to compare vital signs, depth of sedation, induction, treatment and recovery time, intra & post-operative complications and analgesic requirement post-operatively.
Dexmedetomidine; Deep sedation; Analgesia; Propofol; Outpatient; Pediatric dentistry
Ferah Rehman, Ashima Goyal, Krishan Gauba, Kajal Jain, Aditi Kapur. Safety and Efficacy of IV Dexmedetomidine as an Adjunct to Propofol to Sedate Anxious and Uncooperative Pediatric Dental Patients: A Randomized Controlled Trial. Journal of Clinical Pediatric Dentistry. 2021; 45(6): 428-432. doi: 10.17796/1053-4625-45.6.10
1 Jason Leitch and Avril Macpherson Current state of sedation/analgesia care in dentistry. Curr Opin Anaesthesiol 2007;20:384–387.
2 M. O. Folayan, A. Faponle & A. Lamikanra. A review of the pharmacological approach to the management of dental anxiety in children. International Journal of Paediatric Dentistry 2002;12:347–354.
3 Malviya S, Voepel LT, Eldevik OP et al. Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth 2000; 84: 743–8.
4 Tramer MR, Moore RA, McQuay HJ. Propofol and bradycardia: causation, frequency and severity. Br J Anaesth 1997; 78: 642–51
5 Aun CS. New i.v. agents for paediatric patients. Br J Anaesth 1999; 83: 29–41.
6 Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs 2000;59:263–70.
7 Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia 1999;54:146–65.
8 Bekker A, Sturaitis MK. Dexmedetomidine for neurological surgery. Neurosurgery 2005;57(1 Suppl.):110.
9 Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000;90:699–705.
10 UstunY, GunduzM,Erdogan O, BenlidayiME. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg 2006;64:1353–8.
11 Takayuki Kunisawa. Dexmedetomidine hydrochloride as a long-term Sedative. Review. Therapeutics and Clinical Risk Management 2011:7 291–299.
12 Koroglu A, Teksan H, Sagir O, et al. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging. Anesth Analg 2006;103:63-67.
13 Uzümcügil F, Canbay O, Celebi N, Karagoz AH, Ozgen S. Comparison of dexmedetomidine-propofol vs. fentanyl-propofol for laryngeal mask insertion. Eur J Anaesthesiol. 2008;25(8):675-80.
14 Heard C, Burrows F, Johnson K, et al. A comparison of dexmedetomidine- midazolam with propofol for maintenance of anesthesia in children undergoing magnetic resonance imaging. Anesth Analg 2008;107:1832-1839.
15 Mahmoud M, Gunter J, Donnelly LF, et al. A comparison of dexmedetomidine with propofol for magnetic resonance imaging sleep studies in children. Anesth Analg 2009;109:745-753.
16 Koruk S, Mizrak A, Kaya Ugur B, Ilhan O, Baspinar O, Oner U. Propofol/ dexmedetomidine and propofol/ketamine combinations for anesthesia in pediatric patients undergoing transcatheter atrial septal defect closure: a prospective randomized study. Clin Ther. 2010;32(4):701-9.
17 Venn RM, Grounds RM.Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions. Br J Anaesth. 2001;87 (5):684-90.
18 Samia Elbaradie, Faten H. EL Mahalawy and Amira H. Solyman. Dexmedetomidine vs. Propofol for Short-Term Sedation of Postoperative Mechanically Ventilated Patients. Journal of the Egyptian Nat. Cancer Inst. 2004;16(3): 153-158.
19 Tsai CJ, Chu KS, Chen TI, Lu DV, Wang HM, Lu IC.A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation. Anaesthesia. 2010;65(3):254-9.
20 Yokota H, Yokoyama K, Noguchi H, Nishioka T, Umegaki O, Komatsu H, Sakaki T.Post-operative dexmedetomidine-based sedation after uneventful intracranial surgery for unruptured cerebral aneurysm: comparison with propofol-based sedation. Neurocrit Care. 2011;14(2):182-7.
21 Woon-Seok Kang, Sung-Yun Kim et al. The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia. Korean J Anesthesiol 2012; 62(2): 113-118.
22 Mason KP, Zgleszewski SE, Dearden JL, et al. Dexmedetomidine for pediatric sedation for CT imaging studies. Anesth Analg. 2006;103:57-62.
23 Jalonen J, Hynynen M, Kuitunen A, Heikkila H, Perttila J, Salmenpera M, Valtonen M, Aantaa R, Kallio A. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 1997;86:331–45.
24 Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Pediatr Anesth 2005;15:762-6.
25 Erdil F, Demirbilek S, Begec Z, et al. The effects of dexmedetomidine and fentanyl on emergence characteristics after adenoidectomy in children. Anaesth Intensive Care 2009;37:571-6.
26 Ibacache ME, Munoz HR, Brandes V, Morales AL. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg 2004;98:60-3.
27 Isik B, Arslan M, Tunga AD, Kurtipek O. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Pediatr Anesth 2006;16:748-53.
28 Erdil F, Demirbilek S, Begec Z, et al. The effects of dexmedetomidine and fentanyl on emergence characteristics after adenoidectomy in children. Anaesth Intensive Care 2009;37:571-6.
29 Ibacache ME, Munoz HR, Brandes V, Morales AL. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg 2004;98:60-3.
30 Tramer MR, Moore RA, McQuay HJ. Propofol and bradycardia: causation,frequency and severity. Br J Anaesth 1997; 78: 642–51
31 Aun CS. New i.v. agents for paediatric patients. Br J Anaesth 1999; 83: 29–41.
32 Rajashekhar Siddappa, Jessica Riggins, Shathabish Kariyanna, Paul Calkins and Alexandre T. Rotta. High-dose dexmedetomidine sedation for pediatric MRI. Pediatric Anesthesia 2011;21:153–158.
33 Takayuki Kunisawa et al. Dexmedetomidine can stabilize hemodynamics and spare anesthetics before cardiopulmonary bypass. J Anesth 2011; 25:818–822.
34 Woon-Seok Kang, Sung-Yun Kim et al. The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia. Korean J Anesthesiol 2012; 62(2): 113-118.
35 Cheung CW et al. Evaluation of the analgesic efficacy of local dexmedetomidine application. Clin J Pain. 2011;27(5):377-82.
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