DOI QR코드

DOI QR Code

Patient-controlled sedation using remimazolam during third molar extraction: a case report

  • Kyung Nam Park (Department of Dental Anesthesiology, School of Dentistry, Seoul National University) ;
  • Myong-Hwan Karm (Department of Dental Anesthesiology, School of Dentistry, Seoul National University) ;
  • Kwang-Suk Seo (Department of Dental Anesthesiology, School of Dentistry, Seoul National University) ;
  • Hyun Jeong Kim (Department of Dental Anesthesiology, School of Dentistry, Seoul National University) ;
  • Seung-Hwa Ryoo (Department of Dental Anesthesiology, School of Dentistry, Seoul National University)
  • 투고 : 2024.01.02
  • 심사 : 2024.01.16
  • 발행 : 2024.02.01

초록

Dental sedation plays a pivotal role in alleviating patient anxiety during various procedures. Remimazolam, a benzodiazepine derivative, stands out for its distinctive attributes, particularly its rapid onset of sedation coupled with a brief duration, making it an invaluable option for dental applications. The patient was admitted for the extraction of impacted third molars via patient-controlled sedation and not only demonstrated stable vital signs but also expressed a high level of satisfaction with the procedure. An in-depth analysis of plasma remimazolam concentrations and changes in the Patient State Index revealed negative correlation patterns, highlighting the inherent potential of remimazolam in achieving effective sedation. This expanded research scope aims to provide a more nuanced understanding of the pharmacological responses to remimazolam in dental sedation scenarios. This case report offers valuable insights into the evolving landscape of dental sedation methodologies and paves the way for a more informed and evidence-based approach to the use of remimazolam in patient-controlled sedation.

키워드

참고문헌

  1. Southerland JH, Brown LR. Conscious intravenous sedation in dentistry: a review of current therapy. Dent Clin North Am 2016; 60: 309-46.  https://doi.org/10.1016/j.cden.2015.11.009
  2. Rodrigo MR, Tong CK. A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery. Anaesthesia 1994; 49: 241-4.  https://doi.org/10.1111/j.1365-2044.1994.tb03431.x
  3. Seo KS, Lee K. Smart syringe pumps for drug infusion during dental intravenous sedation. J Dent Anesth Pain Med 2016; 16: 165-73.  https://doi.org/10.17245/jdapm.2016.16.3.165
  4. Girdler NM, Rynn D, Lyne JP, Wilson KE. A prospective randomised controlled study of patient-controlled propofol sedation in phobic dental patients. Anaesthesia 2000; 55: 327-33.  https://doi.org/10.1046/j.1365-2044.2000.01279.x
  5. Oka S, Satomi H, Sekino R, Taguchi K, Kajiwara M, Oi Y, Kobayashi R. Sedation outcomes for remimazolam, a new benzodiazepine. J Oral Sci 2021; 63: 209-11.  https://doi.org/10.2334/josnusd.21-0051
  6. Rogers WK, McDowell TS. Remimazolam, a short-acting gaba(a) receptor agonist for intravenous sedation and/or anesthesia in day-case surgical and non-surgical procedures. IDrugs 2010; 13: 929-37. 
  7. Antonik LJ, Goldwater DR, Kilpatrick GJ, Tilbrook GS, Borkett KM. A placebo- and midazolam-controlled phase i single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (cns 7056): Part i. Safety, efficacy, and basic pharmacokinetics. Anesth Analg 2012; 115: 274-83.  https://doi.org/10.1213/ANE.0b013e31823f0c28
  8. Pastis NJ, Yarmus LB, Schippers F, Ostroff R, Chen A, Akulian J, et al. Safety and efficacy of remimazolam compared with placebo and midazolam for moderate sedation during bronchoscopy. Chest 2019; 155: 137-46.  https://doi.org/10.1016/j.chest.2018.09.015
  9. Wiltshire HR, Kilpatrick GJ, Tilbrook GS, Borkett KM. A placebo- and midazolam-controlled phase i single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (cns 7056): Part ii. Population pharmacokinetic and pharmacodynamic modeling and simulation. Anesth Analg 2012; 115: 284-96.  https://doi.org/10.1213/ANE.0b013e318241f68a
  10. Kim KM, Bang JY, Lee JM, Yang HS, Choi BM, Noh GJ. Effect-site concentration of remimazolam at loss and recovery of responsiveness during general anesthesia: a simulation study. Anesth Pain Med (Seoul) 2022; 17: 262-70.  https://doi.org/10.17085/apm.21121
  11. Masui K. Remimazolam besilate, a benzodiazepine, has been approved for general anesthesia!! J Anesth 2020; 34: 479-82.  https://doi.org/10.1007/s00540-020-02755-1
  12. Oue K, Oda A, Shimizu Y, Takahashi T, Kamio H, Sasaki U, et al. Efficacy and safety of remimazolam besilate for sedation in outpatients undergoing impacted third molar extraction: a prospective exploratory study. BMC Oral Health 2023; 23: 774. 
  13. Swart R, Maes SSA, Cavanaugh D, Mason KP. Remimazolam pilot for office-based dental sedation: adverse events, awareness and outcomes. J Clin Med 2023; 12: 7308. 
  14. Morimoto Y. Efficacy and safety profile of remimazolam for sedation in adults undergoing short surgical procedures. Ther Clin Risk Manag 2022; 18: 95-100.  https://doi.org/10.2147/TCRM.S304556
  15. Zhang J, Cairen Z, Shi L, Pang S, Shao Y, Wang Y, et al. Remimazolam versus propofol for procedural sedation and anesthesia: a systemic review and meta-analysis. Minerva Anestesiol 2022; 88: 1035-42. https://doi.org/10.23736/S0375-9393.22.16817-3