Dental treatment of a patient with central sleep apnea and phobic anxiety under sedation: report of a case and clinical considerations


ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY ORAL RADIOLOGY, vol.114, no.5, 2012 (SCI-Expanded) identifier identifier identifier


Central sleep apnea (CSA) results from a reduction in lack of output from the central respiratory generator in the brainstem, manifesting as apneas and hypopneas without discernible efforts. CSA can lead to hypercarbia, arrhythmias, pulmonary hypertension, and heart failure. Indeed, the patient may develop a disturbed breathing during sedation procedures. We report a patient who was diagnosed with CSA and had been on continuous positive airway pressure (CPAP) therapy for 5 years. He was referred for multiple tooth extractions under sedation owing to severe gag reflex and phobic anxiety disorder. The treatment was completed uneventfully under N2O and sevoflurane inhalation accompanied by midazolam and ketamine induction. The role of sedative, analgesic, and anesthetic agents as a precipitating factor for CSA is of particular concern. The combined administration of midazolam, ketamine, sevoflurane, and N2O/O-2 is a useful and safe option for patients requiring sedation. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:e9-e11)