A comparision of intravenous sedation with dexmedetomidine and midazolam for unilateral third molar extraction under local anaesthesia

Abstract

Aim. To compare dexmedetomidine and midazolam for intravenous sedation during unilateral third molar extraction under local anaesthesia.

Methods. The study was double blind. Patients were randomised to receive either dexmedetomidine (up to 1 mcg/kg) or midazolam (up to 5 mg). The drug was infused until the Ramsay Sedation Score reached 4 or the maximum dose had been administered. Intraoperative vital signs and adverse events were recorded. Numerical rating pain scores and analgesic consumption were charted up to three days after surgery. Mini Mental State Examination (MMSE) scores before and after surgery were compared. Amnesia was tested by asking patients to recall two pictures shown after sedation.

Results. Forty-four patients have been recruited and undergone interim analysis. Sedation was achieved by median doses of 0.9O mcg/kg [dexmedetomidine] or 3.55 mg [midazolam]. Desaturation (SpO2 occurred in 5 patients (23%) who received dexmedetomidine and 4 patients (18%) who received midazolam. There was no significant difference in respiratory rate. Heart rate and blood pressure were lower in dexmedetomidine group during surgery. Patients' and surgeons' satisfaction, pain scores and MMSE scores did not differ significantly between groups. Midazolam was associated with greater amnesia.

Conclusions. Our preliminary results show that dexmedetomidine produces comparable sedation to midazolam, with lower haemodynamic parameters and less amnesic effect. © 2007 The American Dental Society of Anesthesiology