Procedural Sedation in Dentistry Using Alpha-2 Agonists: Clinical Cases

Abstract

BACKGROUND: The presence of acute pain is a serious condition, perhaps, the most terrible negative feeling of a person. Therefore, it is advisable to intraoperatively use means of acute pain control for comfort and to prevent the formation of chronic pain syndrome. Using a multimodal approach to acute pain management allows for better outcomes. The more we engage antinociceptive receptors to control pain, the more comfortable our patient feels. Alpha-2-adrenergic agonists clonidine became an important part of the anesthesiologist's set in the perioperative period. It is the selective effect of dexmedetomidine on alpha-2a central and peripheral receptors and alpha-2c receptors that made it possible to use the drug more widely during procedural sedation. The joint use of several drugs for procedural sedation is aimed at obtaining the maximum possible comfort for the patient, the attending physician, and the anesthesiology team, reducing the medication load and awakening as soon as possible. Gaining practical experience in using certain combinations of drugs and analyzing useful negative effects helps to balance and satisfy all needs. PERSONAL EXPERIENCE. Two clinical cases with a typical development but differing in surgical load are presented, describing the effects associated with the use of Precedex (dexmedetomidine hydrochloride) in the introduction of procedural sedation in ambulatory dentistry. CONCLUSIONS. The use of clonidine or dexmedetomidine (Precedex) intraoperatively together with propofol during procedural sedation in ambulatory dentistry allows reliable control of pain in the perioperative period when basic traditional drugs (acetaminophen, NSAIDs) are used in safe doses, reduces the maintenance dose of propofol during the procedure, prevents the vomiting reflex, provides the possibility of comfortable execution of the doctor's commands (surgeon, implantologist, orthopedics) and faster transfer of the patient to the recovery room.