Postoperative sedation with a combination of dexmedetomidine hydrochloride and propofol with patient-controlled sedation in patients undergoing oral and maxillofacial surgery

We studied the postoperative sedation with the combination of dexmedetomidine hydrochloride (DEX) and propofol using patient-controlled sedation (PCS) in patients undergoing oral and maxillofacial surgery whose tracheal tube was kept in place for their postoperative care. The study was conducted at the Okayama University Hospital between November 2005 and May 2007. The patients were divided into 2 groups : (1) DEX alone (DEX group : 20 patients), and (2) the combination of DEX and propofol with PCS (DEX + PCS group : 10 patients). Sedation was given to the patients at the sedation level of a Ramsay Score 3 or 4 in both groups. We retrospectively investigated the age, gender, and weight of the patients, as well as the type of surgery, sedative dose, and side effects in each group. Postoperative patients discomfort and amnesia were obtained from the answers to the questionnaire given a week after surgery, and the data were analyzed statistically with the Fisher's exact test or the Mann-Whitney test There were no significant differences in the demographic data (Table 1 ). The dose of DEX was 0.59±0.20 μg/kg/h in the DEX group, and 0.42±0.07μg/kg/h in the DEX + PCS group. Significantly higher doses of DEX was needed in the DEX group, compared with the DEX + PCS group (p = 0.021) (Table 2). The rate of patients who felt uncomfortable during postoperative sedation was 80.0% in the DEX group, and 40.0% in the DEX + PCS group. The rate of patients who felt uncomfortable during postoperative sedation was significantly lower in the DEX + PCS group than in the DEX group (p = 0.045) (Fig. 1). The rate of patients who had amnesia was 10.0% in the DEX group and 20.0% in the DEX + PCS group. There were no significant differences in the rate of patients having amnesia between the two groups (Fig. 1). In conclusion, the results suggest that postoperative sedation with the combination of DEX and propofol PCS effectively reduced the postoperative discomfort of patients undergoing oral and maxillofacial surgery while keeping the tracheal tube in place for their postoperative care.