A recent case report published in Anesthesia Progress highlights the successful use of the ultrashort-acting benzodiazepine remimazolam for deep sedation during dental surgery. Researchers from the University of Pittsburgh documented an 86-year-old patient who underwent surgical extraction of three molars using a single-agent total intravenous anesthetic (TIVA) approach with remimazolam. The patient remained stable, experienced no adverse effects, and quickly regained full awareness after the procedure, reporting high satisfaction with his care. The findings suggest remimazolam may offer a promising option for managing dental anxiety and sedation, though further studies are needed to confirm its safety and efficacy.
GLEN ALLEN, Va., Sept. 24, 2025 /PRNewswire-PRWeb/ -- As 6-month dental check-ups, cosmetic dentistry and implants have become more standard, anxiety around dental procedures remains a constant issue. More techniques have been developed to assist people of all ages in managing their dental anxieties, from picture books about first-time trips to the dentist for children to biofeedback techniques for adults, and even the introduction of anti-anxiety medications, but the inherent "fear of the dentist" still holds firm for many individuals.
To assess the use of the ultrashort-acting benzodiazepine, remimazolam, during surgical tooth extraction, researchers from the University of Pittsburgh, Pittsburgh, Pennsylvania, recently published a study in the current issue of Anesthesia Progress. Lead author Alexander J. DeBernardo, DMD, and colleagues state, "There has been no previous documentation of a single-agent total intravenous anesthetic (TIVA) approach utilizing remimazolam with a manually adjusted infusion pump for an elderly patient during a painful procedure. In this case report, we present an 86-year-old man who received remimazolam as a single-agent TIVA approach during the extraction of 3 molar teeth."
This case report follows an 86-year-old, White man who underwent general anesthesia for the surgical extraction of three molars. He had no significant prior medical history of concern for the procedure and reported a healthy, active lifestyle. The patient was infused with remimazolam that was manually titrated from 15 mg/h to 30 mg/h over 28 minutes, with a total dose of 14.1 mg, to achieve deep sedation.
The patient's vitals remain stable during the entirety of the procedure. He was immediately alert upon regaining consciousness and appropriately aware of his surroundings. He reported no post-procedural adverse effects, including brain fog, nausea, dizziness, headache or pain. His mental state remained unchanged during a check-in phone call 24 hours later. The patient claimed he was satisfied with the outcome of his care and rated the surgery at a 9 of 10.
This case report shows a positive outcome for a preoperative anesthetic plan that included a TIVA approach using remimazolam for deep sedation and a natural airway. Although the patient did report having severe dental anxiety and had an elevated preoperative blood pressure reading, his blood pressure during the procedure decreased and remained within normal ranges. DeBernardo et al. conclude that "This case report describes the successful use of remimazolam as an infusion for deep sedation in an elderly patient undergoing dental extractions. However, additional studies are needed to further characterize the safety and efficacy of remimazolam administered via manually adjusted infusions."
View the article abstract for "Single-Agent Total Intravenous Anesthesia With Remimazolam for an Elderly Man Undergoing Ambulatory Oral Surgery: A Case Report," Anesthesia Progress, Vol. 72, No. 3, 2025 here.
Anesthesia Progress is the official publication of the American Dental Society of Anesthesiology (ADSA). The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry. The journal invites submissions of review articles, reports on clinical techniques, case reports, and conference summaries. Learn more about ADSA here.
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SOURCE Anesthesia Progress
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