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Thesis Leach Submission 2015.pdf (1.03 MB)

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Postoperative Analgesic Effect of Intravenous Dexmedetomidine in Mandibular Third Molar Extractions

Leach, Sarah Marks
http://rave.ohiolink.edu/etdc/view?acc_num=osu1443791551

Abstract Details

2015, Master of Science, Ohio State University, Dentistry.
Purpose: To evaluate the efficacy of intraoperative intravenous dexmedetomidine in the management of postoperative analgesia, its impact on recovery time, and surgical operating conditions in mandibular third molar extractions. Methods: Nineteen healthy adult volunteers aged 18-40 years, who had already consented to the removal of bilateral mandibular third molars with local anesthesia and intravenous sedation were introduced to this study and offered the opportunity to participate in this randomized cross-over clinical investigation. Two sedation protocols were employed in the study: protocol A - the control sedation (2 mcg/kg Fentanyl followed by propofol infusion) and protocol B – the experimental sedation (1 mcg/kg dexmedetomidine infusion over 10 minutes followed by propofol infusion). The numbers 1-20 were randomly assigned to participants as they were scheduled for their first appointment. Patients received either the control or experimental protocol at their first appointment based on their randomized assignment and then received the other option at the second appointment. Following each sedation, postoperative pain scores were recorded as the patient arrived in PACU, at patient discharge, and 6 hours postoperatively. Additionally, the surgeon was asked to grade the operating conditions and level of patient cooperation experienced during the sedation. Surgical time and time in PACU until discharge were both recorded. After the final appointment, the patient was contacted and asked to rate their sedation preference. Results: Eighteen patients completed the study. Pain scores between groups were not significantly different upon the arrival to PACU, at discharge, at 6 hours postoperatively, or at the time of taking the first pain pill. However, in both groups, there was an expected difference in pain scores between both arrival and discharge from PACU to the time the first pain pill was taken. The time interval between discharge and the first pain pill was significantly different with a p-value of 0.0078. This time was about 1 hour longer in the patients following the experimental sedation (3.55 hours) than the control sedation (2.59 hours). The only other component proving to have a measurable difference was the discharge time based on the sedation protocol (p = 0.0084). Recovery time was on average four minutes longer following the experimental sedation compared to the control sedation. Surgeon’s grade of operating conditions was not significant, however showed greater variability in the grading of cases with the experimental sedation and more predictable operating conditions with the control sedation. Patient preference was not significant. Conclusion: Dexmedetomine is an alpha-2 agonist with anxiolytic, sedative and analgesic properties that can be safely used in ambulatory anesthesia for dental and oral surgery procedures. Its unique properties of having no appreciable effect on respiratory drive, providing longer lasting analgesia, attenuating the sympathoadrenal response to stress, increasing the opioid-free interval, and providing for a comfortable recovery may be beneficial in treatment of specific patients, such as patients diagnosed with obstructive sleep apnea, obesity, systemic hypertension or preexisting myocardial ischemia. More research in this area is necessary to investigate other combinations of sedative adjuncts with dexmedetomidine and its potential impact on outpatient anesthesia.
Simon Prior, BDS, PhD, MS (Advisor)
Megann Smiley, DMD, MS (Committee Member)
William Johnston, MS, PhD (Committee Member)
47 p.
Dentistry; Medicine; Pharmacology
anesthesiology dexmedetomidine sedation dentistry postoperative analgesia ohio state dentist anesthesiologist

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Citations

  • Leach, S. M. (2015). Postoperative Analgesic Effect of Intravenous Dexmedetomidine in Mandibular Third Molar Extractions [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1443791551

    APA Style (7th edition)

  • Leach, Sarah. Postoperative Analgesic Effect of Intravenous Dexmedetomidine in Mandibular Third Molar Extractions . 2015. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1443791551.

    MLA Style (8th edition)

  • Leach, Sarah. "Postoperative Analgesic Effect of Intravenous Dexmedetomidine in Mandibular Third Molar Extractions ." Master's thesis, Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1443791551

    Chicago Manual of Style (17th edition)

osu1443791551
416
© 2015, all rights reserved.
This open access ETD is published by The Ohio State University and OhioLINK.