Makary Laila, Vornik Vadim, Finn Richard, Lenkovsky Fima, McClelland Allan L, Thurmon Jeremy, Robertson Brian
University of Texas Southwestern Medical Center, Dallas Veterans Affairs Medical Center, North Texas North Texas Health Care System, Dallas, TX, USA.
J Oral Maxillofac Surg. 2010 Feb;68(2):386-91. doi: 10.1016/j.joms.2009.09.107.
Office-based oral and maxillofacial surgical procedures that require sedation are popular. Dexmedetomidine has the advantages of having a minimal effect on respiration and an antisialogogue effect that could make it a good choice for dental procedures.
We performed a prospective pilot study in which patients undergoing office-based oral and maxillofacial surgical procedures received dexmedetomidine as a sole sedative agent. The loading dose of dexmedetomidine (1 microg/kg infused over 10 minutes) was followed by a maintenance dose (0.2 to 0.8 microg/kg/hour) to achieve a Ramsay sedation score of 2 to 3. The demographic data were collected, and the pre- and intraprocedural vital signs and Ramsay sedation score were recorded every 5 minutes. The duration of the procedure, recovery time, and patient and surgeon satisfaction were documented.
No statistically significant changes were found in the heart rate, respiratory rate, or oxygen saturation during the procedure when compared to baseline. However, we noticed a significant decrease in the heart rate at the end of the loading dose, and statistically significant change in the blood pressure between baseline and during the procedure (P < .05). The initial local anesthetic injections were recalled by 26% of the patients, and 73% had some recollection of the procedure. Nevertheless, the patient satisfaction score (range 1 to 10) was 8.6 +/- 2.3, and 86% of the patients would recommend this type of sedation. The surgeon satisfaction score (range, 1 to 5) was 3.9 +/- 1.3. The recovery time was prolonged (82.2 +/- 24.3 minutes) when compared with the total procedure time (44.6 +/- 27.9 minutes).
Dexmedetomidine has demonstrated hemodynamic and respiratory stability when used as a sole sedative agent. Despite the discomfort on injection and the lack of reliable amnesic property, patient and surgeon satisfaction were high. However, the prolonged recovery time makes this drug unsuitable for busy office-based practices. We believe it should be reserved for patients with a high risk of respiratory complications (eg, obese patients or those with a history of sleep apnea).
需要镇静的门诊口腔颌面外科手术很常见。右美托咪定具有对呼吸影响极小以及抗唾液分泌作用的优点，这使其可能成为牙科手术的理想选择。
我们进行了一项前瞻性初步研究，其中接受门诊口腔颌面外科手术的患者接受右美托咪定作为唯一的镇静剂。右美托咪定的负荷剂量（10分钟内输注1微克/千克）之后是维持剂量（0.2至0.8微克/千克/小时），以达到Ramsay镇静评分2至3分。收集人口统计学数据，每5分钟记录术前和术中的生命体征及Ramsay镇静评分。记录手术持续时间、恢复时间以及患者和外科医生的满意度。
与基线相比，手术过程中心率、呼吸频率或血氧饱和度无统计学显著变化。然而，我们注意到负荷剂量结束时心率显著下降，且基线与手术过程中血压有统计学显著变化（P < 0.05）。26%的患者回忆起最初的局部麻醉注射，73%的患者对手术有一些记忆。尽管如此，患者满意度评分（范围1至10）为8.6±2.3，86%的患者会推荐这种镇静方式。外科医生满意度评分（范围1至5）为3.9±1.3。与总手术时间（44.6±27.9分钟）相比，恢复时间延长（82.2±24.3分钟）。
右美托咪定作为唯一的镇静剂使用时已显示出血流动力学和呼吸稳定性。尽管注射时有不适且缺乏可靠的遗忘作用，但患者和外科医生的满意度较高。然而，恢复时间延长使得这种药物不适合繁忙的门诊手术。我们认为它应保留用于有呼吸并发症高风险的患者（如肥胖患者或有睡眠呼吸暂停病史的患者）。
