Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting

Introduction: For a patient to be deemed as American Society of Anesthesiologists (ASA) type III or IV, that patient must have a severe systemic disease that may constitute a constant threat to their daily life. Examples of these medical conditions include, but are not limited to, myocardial infarction, cerebral vascular accident, sepsis, and end-stage renal disease. For many of these patients, removal of teeth is required prior to invasive cardiothoracic procedures, in order to prevent or reduce the risk of infection, including bacterial endocarditis. The American Dental Association (ADA), along with the ASA recommend the use of deep sedation/general anesthesia in these instances. Objective: Presently, there is no leading literature comparing different anesthetic regimens that are the most commonly used and most effective for these procedures involving exodontia. The purpose of this report is to examine the most common sedative/general anesthetic regimens utilized for dentoalveolar surgery in an operating room setting, for ASA III and IV patients who require invasive cardiothoracic surgery. Methods: In this study, 54 ASA III and IV patients who required cardiothoracic surgery, underwent sedation or general anesthesia for extraction of teeth in an operating room setting 1 to 2 days prior to undergoing invasive cardiothoracic surgery. These exodontia procedures were grouped into 3 case series: under 30 minutes, 30-60 minutes, and greater than 60 minutes in duration. Conclusions: In all 3 series, midazolam, propofol, dexmedetomidine, and fentanyl were the most frequently used agents, alone or in combination. This demonstrates the fact that the sedative/anesthetic regimens utilized for dentoalveolar surgery in the operating room are similar to those utilized in outpatient oral and maxillofacial surgery settings.