Dental treatment under long-term sedation (Dexdor)

What is deep sedation?

This is a sedation method that is often used in modern dentistry.
You are lying in a dental chair, the medicine has a fairly strong sedative effect on you - you are absolutely relaxed, nothing bothers you, you almost fall asleep. But at the same time, you are conscious, breathe on your own, control your body, and can fulfill the doctor’s requests. Our anesthesiologists and dentists (therapists, orthopedists, implant surgeons) are specialists in deep sedation treatment (with the drug Dexdor). It has been used in dentistry for many years and has a high safety profile.

We provide treatment with Dexdor according to JCI standards. This means that during treatment under deep sedation, all safety measures are strictly observed.

A team of anesthesiologists monitors you every second throughout your treatment. We monitor according to the Harvard standard - we track all your vital signs.

Description of the drug DEXDOR

Dexmedetomidine is for use in the ICU only.

During the infusion, cardiovascular functions should be constantly monitored.

In patients who are not intubated, respiratory function should be monitored.

Use with caution in combination with other drugs that have a sedative effect or affect the cardiovascular system due to the risk of additive effects.

Given its pharmacodynamic effects, dexmedetomidine should be used with caution in patients with severe bradycardia, progressive heart block (2nd-3rd degree AV block, unless a pacemaker is used), hypotension, or in patients with severe ventricular dysfunction. Dexmedetomidine reduces the activity of the sympathetic nervous system, so patients with hypovolemia, chronic arterial hypertension and elderly patients can expect the development of more severe arterial hypotension/bradycardia.

Patients with good physical fitness and low resting heart rate may be particularly sensitive to the bradycardic effects of α2-adrenergic agonists; There are reports of temporary cessation of sinus node activity.

Hypotension and bradycardia usually do not require treatment, but if necessary, hypotension should be treated with vasoconstrictors and/or fluid administration and bradycardia with anticholinergics.

Use with caution in patients with coronary artery disease, because there is a risk of significant arterial hypo- or hypertension, since there is a theoretical possibility of a decrease in coronary blood flow due to peripheral vasoconstriction mediated by stimulation of α2-adrenergic receptors. If signs of myocardial ischemia appear on the ECG, the advisability of reducing the dose or discontinuing the drug should be considered.

In patients with impaired autonomic nervous system activity (eg, due to spinal cord lesions), more pronounced hemodynamic changes are possible after initiation of dexmedetomidine, so dexmedetomidine should be used with caution in these patients.

Transient hypertension was observed primarily during loading dose administration, which was associated with the peripheral vasoconstrictor effect of dexmedetomidine. Treatment of hypertension was not usually required, but a reduction in loading dose or infusion rate was recommended.

Compared with propofol and midazolam, patients who become sedated by dexmedetomidine typically arouse more easily, interact better with the physician, and are able to communicate better, remaining generally calm and relaxed. However, the spectrum of clinical action means that dexmedetomidine cannot be used as an independent agent when it is necessary to achieve deep sedation or complete immobility of the patient. If muscle relaxation is necessary (including when performing endotracheal intubation), an alternative sedative should be additionally used in therapeutic doses so that the patient does not regain consciousness during the procedure.

The administration of bolus doses of dexmedetomidine to acutely increase the intensity of sedation has not been evaluated and is not recommended. If sedation is insufficient, especially during the first hours after switching to dexmedetomidine, bolus doses of an alternative sedative may be used.

Dexmedetomidine does not appear to inhibit seizure activity and is therefore not used as the sole treatment for status epilepticus. Experience with dexmedetomidine in severe neurological disorders such as head trauma is limited and should be used with caution in such cases, especially if deep sedation is required.

Like other sedatives, dexmedetomidine can reduce cerebral circulation.

The development of withdrawal reactions cannot be excluded if the use of dexmedetomidine is suddenly stopped.

The use of dexmedetomidine in patients sensitive to malignant hyperthermia is not recommended. In case of prolonged unexplained fever, dexmedetomidine should be discontinued.

There is no experience using dexmedetomidine for more than 14 days.

Use in pediatrics

Safety and effectiveness in children have not been established.

In what cases do we use long-term sedation?

Your doctor may recommend treatment with Dexdor in these cases:

Long-term therapeutic treatment (multiple caries, endodontics)
Large volume of prosthetics (orthopedics)
Small-scale implantation and surgery. If you are faced with complex and extensive implantation or removal of several teeth, then the doctors’ choice is often made in favor of treatment under anesthesia - during sleep.
If you have severe dental phobia
Increased gag reflex
Polyvalent allergy.

In any case, the choice of drug for sedation remains only with your attending physician and anesthesiologist! Please follow the recommendations of our specialists - doctors will suggest the most effective and safe option for you: nitrous oxide, deep sedation or sleep treatment.

Contraindications

acute cerebrovascular pathologies;
uncontrolled arterial hypotension;
atrioventricular block of II–III degree (in cases where there is no artificial pacemaker);
lactation period;
age under 18 years;
individual intolerance to the components of the drug.

The use of Dexdor in pregnant women is possible only in cases of extreme necessity (due to the lack of data confirming the safety/efficacy of the drug).

What do you need before sedation treatment with Dexdor?

You will have a consultation with an anesthesiologist. The doctor will collect an anamnesis, take into account all your possible concomitant diseases, and select a sedation option that is effective and safe in your case.

You will be prescribed a set of examinations before treatment under sedation (tests, ECG with orthostatic test, appointment with a therapist). It is necessary!

Dental treatment with deep sedation (Dexdor): reviews

Ekaterina April 24, 2021

I would like to express my HUGE THANKS to the anesthesiologist Igor Valerievich Godomsky for the excellent anesthesia he performed on me. For the well-chosen drugs for anesthesia (I previously had big problems and complications with certain drugs), the doctor approached my problem very carefully, listened to everything, selected the types analyzes, thought everything through correctly! I'm very happy! And, my family too! Thank you very much Igor Valerievich ️

DariaDecember 12, 2020

For several years I decided to have my lower impacted wisdom teeth removed. I visited several surgeons: someone offered to remove two teeth for me in 4 stages with a difference of six months, others sent me to the jaw, some said “a matter of 5 minutes, now we’ll remove everything.” I probably could have been looking for that ideal doctor for a long time if one day they had not recommended Dr. Volberg Roman to me. I always trust my intuition:) At first glance, the doctor inspires confidence. He suggested I have two teeth removed at a time under sedation. The operation went well, the swelling had already disappeared after a week, there were no complications and no loss of sensitivity in the lower third of the face, which is often warned about. Two weeks later, she visited a dental therapist, she said that the surgeon was a virtuoso, as if there had been no operation, the condition of the mucous membranes was ideal. Roman Vyacheslavovich is also a caring and attentive doctor, despite his busy schedule, he is always in touch, you can write to him and share your experiences about the tooth) Thank him very much! I would especially like to thank the anesthesiologist Natalya Danilova. She is a true professional in her field and a wonderful person. During the sedation, it lasted about three hours, I slept so well, it was even a little disappointing that they woke me up so quickly :) I didn’t feel any side effects and 15 minutes later I was already on my feet in a cheerful state.

Ekaterina April 24, 2021

Answer:

Ekaterina, we are glad that everything went well and that you were left with pleasant emotions from the treatment process! We wish you good health!

Belgravia Dental Studio Team

DariaDecember 12, 2020

Answer:

Daria, we are very glad that you found your doctor! This is always very important! We wish you a bright smile for many years to come!

Belgravia Dental Studio Team

Next review

Medical Internet conferences

Relevance: From medical practice, methods of anesthesia in outpatient settings for dental patients are known. For this purpose, general anesthesia in the form of endotracheal anesthesia or total intravenous anesthesia can be used. Also, for the purpose of pain relief, methods of regional anesthesia can be used, for example, infiltration anesthesia with lidocaine 0.5% or 1% solution at a dose of 400.0 mg. However, these methods have a number of disadvantages. When performing total intravenous anesthesia:

it is difficult to control the depth of anesthesia;
no contact with the patient during anesthesia;
there is a risk of aspiration complications;
side effects of anesthetics can provoke the development of nausea and vomiting in the postoperative period;
Long-term monitoring of the patient’s condition after anesthesia is required;
Often the stress associated with anesthesia exceeds the stress of surgery.

Local infiltration anesthesia:

cannot provide an adequate level of protection for the patient’s psycho-emotional sphere;
does not always provide a sufficient level of anesthesia;
Performing local anesthesia is often associated with pain and emotional distress for the patient.

Purpose: The purpose of this study is to improve the quality of anesthesia in outpatient settings for dental patients.

Material and methods: The proposed method was tested on 23 patients who were treated at the State Budgetary Healthcare Institution JSC “Regional Clinical Dental Center” in Astrakhan in 2014. Before surgery, the patient is given a dexmedetomidine solution with a concentration of 4.0 mcg/ml at a dose of 1.0 mcg/kg of the patient's body weight over 10 minutes by intravenous infusion using a controlled infusion device, after which the infusion rate of the drug is reduced to 1.0 mcg/kg/hour, then local infiltration anesthesia of the surgical area is performed with a solution of articaine hydrochloride 40.0 mg/ml, then surgery is performed, after its completion the dexmedetomidine infusion is stopped, before, during and after the start of anesthesia and surgery, as well as until the patient’s consciousness is fully restored, continuous monitoring of blood pressure, pulse, oxygen saturation, respiratory rate, and ECG is carried out.

Results: The use of a controlled intravenous infusion of dexmedetomidine for sedation allows, firstly, to easily control the patient’s level of sedation, secondly, to avoid the residual effect of the drug after the end of the intervention, thirdly, to maintain full contact between the patient and the medical staff, and fourthly, Dexmedetomidine has a weak analgesic and anesthetic effect, as a result of which the patient’s discomfort during infiltration anesthesia is reduced and the effect of the local anesthetic is potentiated.

Conclusions: The proposed method improves the quality of anesthesia in outpatient settings for dental patients, namely:

comfortable for the patient;
allows you to easily control the depth of sedation;
we achieve full contact between medical personnel and the patient;
the patient’s psycho-emotional stress before the procedure is reduced;
Due to the short half-life, consciousness is quickly restored, and therefore long-term observation after completion of the intervention is not required.

Drug interactions

When Dexdor is used in combination with certain drugs/substances, the following effects may develop:

anesthesia agents, narcotic analgesics, drugs with sedative and hypnotic effects (isoflurane, propofol, alfentanil, midazolam): enhancing their effect (dose adjustment of Dexdor or these drugs may be required);
medications that lead to a decrease in blood pressure and the development of bradycardia, including beta-blockers: enhancing these effects.

Side effects

The most common disorders include decreased/increased blood pressure and bradycardia. The most serious adverse reactions are decreased blood pressure and bradycardia.

Possible side effects (> 10% - very common; > 1% and < 10% - often; > 0.1% and < 1% - uncommon; > 0.01% and < 0.1% - rare; < 0. 01% – very rare):

digestive system: often – nausea, vomiting, xerostomia; uncommon – bloating;
respiratory system: often – respiratory depression; infrequently – apnea, shortness of breath;
metabolism and nutrition: often – hyperglycemia, hypoglycemia; uncommon – hypoalbuminemia, metabolic acidosis;
cardiovascular system: very often – bradycardia, decreased/increased blood pressure; often – myocardial infarction or ischemia, tachycardia; uncommon – decreased cardiac output, first degree atrioventricular block;
psyche: often – agitation; infrequently – hallucinations;
general disorders and local reactions: often – withdrawal syndrome, hyperthermia; infrequently – thirst, ineffectiveness of the drug.