Sedación Analgesia Con Midazolam Y Remifentanil Para Exodoncia Quirúrgica De Terceros Molares. Reporte De Una Serie De Casos

Resumen

En cincuenta pacientes propuestos para exodoncia de terceros molares con sedación intravenosa, se realizó un estudio prospectivo observacional sobre la combinación: midazolam y remifentanilo. Se administró un bolus inicial de midazolam de 0,01 a 0,02 mg/kg. 5 minutos antes y remifentanilo (0,1 μg/kg/min), en 10 minutos o hasta alcanzar un nivel de sedación de Ramsay de 2 a 3, infiltración local con lidocaína 2%. Resultados: Un grado de sedación 2-3 se consiguió en 6 ± 2 minutos. En 48 pacientes (88 %) la cirugía se llevó a cabo con remifentanilo exclusivamente. Los efectos adversos fueron: nauseas postoperatorias 6%; hipotensión 2%. Rescate con propofol: 4%. Satisfacción para el cirujano: muy buena o excelente: 82%. Satisfacción para el paciente: Excelente o muy buena 98%.

Title
Sedation Analgesia with Midazolan and Remifentanil in surgical exodoncy of the third molar. Report of a series
Abstract
A Prospective, observational study was made on the use of remifentanil during third molar surgery. . Fifty patients were subjected to oral surgery under intravenous sedation. Midazolam 0,01 -0,02 mg/kg I.V. 5 minutes prior to remifentanil perfusion (0,01 μg/kg/min ) during 10 minutes or until reaching sedation score 2 or 3 on the Ramsay scale, followed by local infiltration with lidocaine 2%. A sedation grade 2-3 was achieved in 6 ± 2 minutes. In 48 patients (88%), the surgical procedure was performed only with remifentanil. Frequency of adverse events were: postoperative nausea 6%, hypotension 2%. In 4% of patients propofol was required as additional medication. Satisfaction score as evaluated by the performing surgeon was: excellent and very good (S&VG) 82%. Satisfation as evaluated by the patient was: S&VG 98%. Conclusions: Remifentanil is useful as third molar surgery sedoanalgesia method. Serious undesired effects are rare. Further studies are necessary to completely establish its effectiveness and safety in these types of procedures.