Perioperative management using dexmedetomidine for a pediatric patient with osteogenesis imperfecta undergoing dental treatment under general anesthesia

Osteogenesis imperfecta (OS) is an autosomal recessive disease that results in a congenital vulnerability to external forces, easily leading to bone fractures. We performed dental treatment under general anesthesia in a pediatric patient with OS to prevent bone fractures induced by restraint during dental treatment, and the continuous infusion of dexmedetomidine was useful for controlling agitation after the general anesthesia. The patient was a 5-year-old male who had already experienced more than 10 bone fractures; he had been treated with intravenous injections of bisphosphonate every 45 days. General anesthesia for dental treatment was suggested by his parents and was performed twice for dental treatment and teeth extraction. The first and second general anesthesia procedures were performed using the same procedure: premedication with oral midazolam; induction with sevoflurane, remifentanil, and rocuronium; and maintenance with the continuous infusion of propofol and remifentanil. During the middle of the dental treatment procedure, a continuous infusion of 0.4 μg/kg/h of dexmedetomidine was started and continued until 30 minutes after the removal of the tracheal tube. The durations for the infusion of dexmedetomidine were 114 and 170 minutes in the first and second general anesthesia procedures, respectively. Abnormal respiratory and circulatory suppression related to the use of dexmedetomidine was not observed throughout the management period. An adequate level of sedation was obtained after emergence, with a Richmond Agitation-Sedation scale of 2 or less. Thus, the continuous infusion of dexmedetomidine was considered to be useful for preventing agitation after general anesthesia in a pediatric patient In the present case, this management procedure was useful for preventing bone fractures during the perioperative period in a patient with OS.