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Propofol Target Controlled Infusion (TCI) Sedation for Dental Treatment in the Exaggerated Gag Reflex Patient  

Shin, Soonyoung (Department of Dental Anesthesiology, Seoul National University Dental Hospital)
Cha, Min-Joo (Department of Dentistry, School of Dentistry, Seoul National University)
Seo, Kwang-Suk (Department of Dental Anesthesiology, Seoul National University Dental Hospital)
Kim, Hyun-Jeong (Department of Dental Anesthesiology, Seoul National University Dental Hospital)
Lee, Jung-Man (Department of Dental Anesthesiology, Seoul National University Dental Hospital)
Chang, Juhea (Clinic for Persons with Disabilities, Seoul National University Dental Hospital)
Publication Information
Journal of The Korean Dental Society of Anesthesiology / v.12, no.2, 2012 , pp. 105-109 More about this Journal
Abstract
The gag reflex is a physiological reaction, but, an exaggerated gag reflex can be a severe limitation not only to treat dental caries but also to do oral exam. Procedures such as surface anesthesia of the palate and pharyngeral area, sedation, or general anesthesia can be options as behavioral management. But, there are no golden rule for the sever gag reflex patients. We present a case report of propofol intravenous sedation using TCI pump for simple dental treatment. A 44-year-old man, who had past history of general anesthesia for dental treatment because of severe gag reflex, was scheduled intravenous sedation for simple dental treatment. After 8 hour fasting he entered the clinic for persons with disabilities. We explained about intravenous deep sedation and got informed consent. First, we kept intravenous catheter (22G) in the arm and started monitoring ECG, non-invasive blood pressure, pulse oximetry and end-tidal $CO_2$ through nasal cannula. We started propofol infusion with TCI pump at the target concentration of 3 mcg/ml. The patient became sedated, but he showed involuntary movement during dental treatment, so we increased the target concentration to 4 mcg/ml. We finished the dental treatment without complications during 30 min. And after 40 min recovery room stay he was discharged without any complications.
Keywords
Gag reflex; Deep sedation; Dental treatment; Propofol;
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1 Dickinson CM, Fiske J: A review of gagging problems in dentistry: 2. Clinical assessment and management. SADJ 2006;61(6): 258-62, 66.
2 Kumar S, Satheesh P, Savadi RC: Gagging. N Y State Dent J 2011;77(4): 22-7.
3 Yagiela JA: Making patients safe and comfortable for a lifetime of dentistry: frontiers in office-based sedation. J Dent Educ 2001;65(12): 1348-56.
4 Meeker HG, Magalee R: The conservative management of the gag reflex in full denture patients. N Y State Dent J 1986;52(4): 11-4.
5 Conny DJ, Tedesco LA: The gagging problem in prosthodontic treatment. Part I: description and causes. J Prosthet Dent 1983;49(5): 601-6.   DOI   ScienceOn
6 Wright SM: An examination of factors associated with retching in dental patients. J Dent 1979;7(3): 194-207.   DOI   ScienceOn
7 Saunders RM, Cameron J: Psychogenic gagging: identification and treatment recommendations. Compend Contin Educ Dent 1997;18(5): 430-3, 6, 8 passim.
8 Bassi GS, Humphris GM, Longman LP: The etiology and management of gagging: a review of the literature. J Prosthet Dent 2004;91(5): 459-67.   DOI   ScienceOn
9 Conny DJ, Tedesco LA: The gagging problem in prosthodontic treatment. Part II: Patient management. J Prosthet Dent 1983;49(6): 757-61.   DOI   ScienceOn
10 Fiske J, Dickinson C: The role of acupuncture in controlling the gagging reflex using a review of ten cases. Br Dent J 2001;190(11): 611-3.
11 Dies DF, Clarkston WK, Schratz CL: Intravenous ketorolac tromethamine versus meperidine for adjunctive sedation in upper gastrointestinal endoscopy: a pilot study. Gastrointest Endosc 1996;43(1): 6-9.   DOI   ScienceOn
12 Chaushu S, Gozal D, Becker A: Intravenous sedation: an adjunct to enable orthodontic treatment for children with disabilities. Eur J Orthod 2002;24(1): 81-9.   DOI   ScienceOn
13 오세리, 이준: 구역반사가 심한 환자의 임플란트 치료에서 프로포폴과 미다졸람을 이용한 정주진정법 -증례 보고- 대한치과마취과학회지 2010;10: 27-33.
14 Yoshida H, Ayuse T, Ishizaka S, Ishitobi S, Nogami T, Oi K: Management of exaggerated gag reflex using intravenous sedation in prosthodontic treatment. Tohoku J Exp Med 2007;212(4): 373-8.   DOI   ScienceOn
15 Barakat AR, Sutcliffe N, Schwab M: Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models. Anaesthesia 2007;62(7): 661-6.   DOI   ScienceOn