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plasma concentration is not considered to be an effect site. This hypothesis is supported by the measurement of APAP concentrations in cerebrospinal fluid after intravenous (IV) administration in children and adults. 10 , 11 Based on these findings, the administration of APAP 1 to 2 hours before anticipated pain and fever has been recommended in children. 12 Although the early administration of APAP is recommended for the purpose of postoperative analgesia, pharmacokinetic and pharmacodynamic studies of APAP and its exerted effect on postoperative pain are rare. The

. Dexmedetomidine, which causes less respiratory depression than opioids, midazolam, or propofol, 9 , 10 is often used when intravenous sedation is required for dental treatment 11 – 13 and is recommended particularly for patients at risk of respiratory depression. 10 We have performed intravenous sedation for dental treatment in an intellectually disabled patient with type II ACM and hypercapnic respiratory failure on 2 separate occasions: the first using propofol and the second using a combination of dexmedetomidine and midazolam. This report describes our experience with

patients, and to this end, intravenous sedation is often used. 3 , 4 However, when using intravenous sedative drugs that have strong systemic actions on the central nervous, respiratory, and circulatory systems, systemic management to ensure patient safety is a prerequisite. 5 , 6 Conscious sedation is generally preferred to maintain independent breathing and biological defense mechanisms such as coughing and swallowing reflexes. However, dental treatment of patients with disabilities may require behavioral control, especially in the case of mentally challenged

Midazolam has been frequently used for intravenous sedation in dental treatment because of reliable sedation and profound amnesia. Propofol has been applied not only for general anesthesia but also for intravenous sedation by using the bolus or continuous injection technique. It has been reported that the paradox phenomenon, represented by instances of hostility, rage, and physical violence, can be caused by midazolam 1–7 and that delirium is induced by propofol. 8 9 We report 2 episodes of delirium caused by midazolam alone and by

Neurally-mediated syncope (NMS) may be triggered by mental or physical stress and may lead to severe bradycardia. We report a case of NMS leading to cardiac arrest lasting for 31 seconds in a patient with dental phobia who underwent intravenous sedation during her dental treatment. CASE REPORT A 26-year-old woman (height 150 cm, weight 48 kg) was referred to our oral surgery clinic for the removal of impacted right upper and lower wisdom teeth. As she had felt nauseated during dental treatment with local

Dental treatment often involves uncomfortable procedures that require adequate sedation. Intravenous midazolam and propofol have long been used to induce appropriate sedation during dental treatment. In particular, propofol is used in patients with a severe gag reflex. 1 , 2 Midazolam is a fast-acting benzodiazepine with a short elimination half-life. It exhibits sedative, anxiolytic, hypnotic, and anterograde amnesic properties. 3 In addition, flumazenil, a benzodiazepine antagonist, can be used to treat a midazolam overdose. Propofol was

The Patient State Index (PSI) is measured using the SedLine Sedation Monitor (SedLine; Masimo Corporation) proprietary equipment and represents a numerical value of anesthesia depth. However, no study has examined PSI values for moderate sedation. We conducted a case-series study to investigate PSI values during moderate intravenous (IV) sedation for dental treatment. This pilot study was approved by the ethics committee of Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University

This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous (IV) conscious sedation. Hyperventilation can be a manifestation of anxiety and involves abnormally fast breathing (tachypnea) and an elevated minute ventilation that exceeds metabolic demand. 1 This can lead to hypocapnia, a state of abnormally low levels of carbon dioxide in the blood that results from excessive amounts of carbon dioxide being exhaled. Hyperventilation