Alternative sedation premedication with intranasal dexmedetomidine before dental procedures

Abstract

Dental procedures are often necessary for pediatric patients with dental health problems. However, perioperative anxiety and fear is common in this age group. Despite planning intravenous sedatives for the procedures, pediatric patients are often unwilling to cooperate with venipuncture and may actively resist intravascular catheter placement. Unpleasant venipuncture experiences can lead to psychological trauma and increases difficulty to proceed with future treatment. Non-intravenous premedication could be of potential benefit in these situations. In this case report, we discussed the use of intranasal dexmedetomidine as sedation premedication before dental procedures. A 3-year-old boy (body weight, 15 kg and body height, 96 cm) was diagnosed as having dental caries and pulpitis. He was apprehensive of the hospital setting and was easily distressed, making him unable to accept dental procedures under local anesthesia. After consultation with our anesthesiology department, dental management (including composite resin filling, root canal treatment, crown restoration for primary teeth, and application of pit and fissure sealant) was planned to be performed under intravenous sedation with fentanyl and target control infusion (TCI) with propofol. On the day of the procedure, he was pre-medicated with intranasal dexmedetomidine 80 mcg. After 30min, intravenous catheter was installed under mild sedation in the company of family members. Propofol infusion was administered via target controlled infusion pump (Kataria model), with initial effect site concentration set at 2 mcg/ ml. The sedation level was targeted to reach observer’s assessment of alertness/sedation level four. High flow nasal cannula (Optiflow ) was then implemented with FiO2 1.0 and flow rate 30 L/min. The dental treatment was completed smoothly with only a few interruptions due to coughing of the patient. Neither airway obstruction nor desaturation was observed throughout the procedure.