知的能力障害を有する成人歯科患者に対してデクスメデトミジン経鼻投与による麻酔前投薬を試みた1症例

<p>  Oral midazolam is an effective method of premedication for pediatric patients and is also sometimes used as a premedication in adult patients with intellectual disability whose cooperation with anesthesia induction can be difficult to obtain. Recently, the effectiveness of intranasal dexmedetomidine (DEX) as a premedication has been reported. However, most studies have been conducted in pediatric patients, and no reports of adult patients have been made. Here, we present a case report in which premedication using intranasal DEX was performed for an adult patient with intellectual disability.</p><p>  The patient was a 27-year-old female (weight, 48.5 kg) with intellectual disability, epilepsy, and autism spectrum disorder. Dental treatment under general anesthesia was planned because of a lack of cooperation with dental treatment. She had previously received several dental treatments under general anesthesia during which premedication using oral midazolam had been used. However, it became difficult to obtain her cooperation for premedication using oral midazolam during the repeated treatments requiring general anesthesia. Therefore, premedication using nasal DEX was performed. We provided premedication using nasal DEX on two occasions. On the first occasion, 1.0 μg/kg of DEX was sprayed into the nasal passages using MAD Nasal^TM. However, the sedation level was inadequate (Ramsay Sedation Scale 2), and the patients refused the anesthesia induction. On the second occasion, 1.5 μg/kg of DEX was sprayed into nasal the passages in the same manner as that used previously. This time, an appropriate level of sedation (Ramsay Sedation Scale 3) was obtained and the anesthesia induction was successful.</p><p>  The present case report suggests that premedication using intranasal DEX might be a useful method of anesthesia induction for adult patients with intellectual disabilities in whom premedication using oral midazolam is difficult.</p>