Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting

Daniel Joseph Traub; Ethan Harris

doi:doi:10.11648/j.ijacm.20251302.20

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Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting

Daniel Joseph Traub^*

, Ethan Harris

Published in International Journal of Anesthesia and Clinical Medicine (Volume 13, Issue 2)

Received: 5 September 2025 Accepted: 9 October 2025 Published: 30 October 2025

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Abstract

Introduction: For a patient to be deemed as American Society of Anesthesiologists (ASA) type III or IV, that patient must have a severe systemic disease that may constitute a constant threat to their daily life. Examples of these medical conditions include, but are not limited to, myocardial infarction, cerebral vascular accident, sepsis, and end-stage renal disease. For many of these patients, removal of teeth is required prior to invasive cardiothoracic procedures, in order to prevent or reduce the risk of infection, including bacterial endocarditis. The American Dental Association (ADA), along with the ASA recommend the use of deep sedation/general anesthesia in these instances. Objective: Presently, there is no leading literature comparing different anesthetic regimens that are the most commonly used and most effective for these procedures involving exodontia. The purpose of this report is to examine the most common sedative/general anesthetic regimens utilized for dentoalveolar surgery in an operating room setting, for ASA III and IV patients who require invasive cardiothoracic surgery. Methods: In this study, 54 ASA III and IV patients who required cardiothoracic surgery, underwent sedation or general anesthesia for extraction of teeth in an operating room setting 1 to 2 days prior to undergoing invasive cardiothoracic surgery. These exodontia procedures were grouped into 3 case series: under 30 minutes, 30-60 minutes, and greater than 60 minutes in duration. Conclusions: In all 3 series, midazolam, propofol, dexmedetomidine, and fentanyl were the most frequently used agents, alone or in combination. This demonstrates the fact that the sedative/anesthetic regimens utilized for dentoalveolar surgery in the operating room are similar to those utilized in outpatient oral and maxillofacial surgery settings.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 13, Issue 2)
DOI	10.11648/j.ijacm.20251302.20
Page(s)	114-119
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Deep Sedation, General Anesthesia, ASA Classification System, Operating Room, Extractions

References

[1]	Flynn, D. N., et al. Review of the ASA Physical Status Classification: Comment. Anesthesiology 136, 865-866 (2022). https://doi.org/10.1097/ALN.0000000000004146
[2]	Hupp, J. R., Ellis, E., Tucker, M. R. Contemporary Oral and Maxillofacial Surgery, Seventh Edition (Elsevier, 2019).
[3]	Weaver, J. M. ADA’s sedation and anesthesia guidelines pass: will they be universally accepted? Anesthesia Progress 55, 1 (2008). https://doi.org/10.2344/0003-3006(2008)55[1]
[4]	Livhits, M., et al. Risk of Surgery Following Recent Myocardial Infarction. Annals of Surgery (2011) 253.857.
[5]	Glance, L. G., et al. Time Since Prior NSTEMI and Major Adverse Cardiovascular and Cerebrovascular Events after Noncardiac Surgery. JAMA Surg 160, 45-54 (2025). https://doi.org/10.1001/jamasurg.2024.4683
[6]	Lieblich, S., Providing Anesthesia in the Oral and Maxillofacial Surgery Office, Where We Are Now, and a Look Ahead. J Oral Maxillofac Surg 76, 917-925 (2018). https://doi.org/10.1016/j.joms.2018.01.026
[7]	Samulak-Zielinska, R., et al. Dental treatment of post-myocardial infarction patients: A review of the literature. Dent Med Probl 56, 291-298 (2019). https://doi.org/10.17219/dmp/109232
[8]	Ganzberg, S. I., et al. Anesthesia for office-based oral and maxillofacial surgery. Dent Clin North Am. 43 (1999).
[9]	American Association of Oral and Maxillofacial Surgeons. White Paper on Office-Based Anesthesia Provided by the Oral and Maxillofacial Surgeon (2022).
[10]	Hassan, H., et al. Efficacy and cost analysis of intravenous conscious sedation for long oral surgery procedures. British Journal of Oral and Maxillofacial Surgery 62, 523-538 (2024). https://doi.org/10.1016/j.bjoms.2024.04.006
[11]	Cangemi, C. F. Jr. Administration of general anesthesia for outpatient orthognathic surgical procedures. J Oral Maxillofac Surg 69, 798-807 (2011). https://doi.org/10.1016j.joms.2009.07.047
[12]	Mishra, N., et al. Sedation in oral and maxillofacial day care surgery: A comparative study between intravenous dexmedetomidine and midazolam. National Journal of Maxillofacial Surgery 7, 178-185 (2016). https://doi.org/10.4103/njms.NJMS7816
[13]	Singh, V., et al. Dexmedetomidine as an Additive to Local Anesthesia: A Step to Development in Dentistry. J Oral Maxillofac Surg 76 (2018). https://doi.org/10.1016/j.joms.2018.05.037
[14]	Dianne, R. A., et al. Comparing efficacy and safety of four intravenous sedation regimens in dental outpatients. Journal of the American Dental Association 6, 740-752 (2001).
[15]	Jason, A. S., et al. Comparison of the Efficacy of Midazolam and Dexmedetomidine As Sedative Agents in Third Molar Surgery. Cureus 15 (2023). https://doi.org/10.7759/cureus.49477

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APA Style

Traub, D. J., Harris, E. (2025). Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting. International Journal of Anesthesia and Clinical Medicine, 13(2), 114-119. https://doi.org/10.11648/j.ijacm.20251302.20

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ACS Style

Traub, D. J.; Harris, E. Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting. Int. J. Anesth. Clin. Med. 2025, 13(2), 114-119. doi: 10.11648/j.ijacm.20251302.20

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AMA Style

Traub DJ, Harris E. Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting. Int J Anesth Clin Med. 2025;13(2):114-119. doi: 10.11648/j.ijacm.20251302.20

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@article{10.11648/j.ijacm.20251302.20,
  author = {Daniel Joseph Traub and Ethan Harris},
  title = {Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting
},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {13},
  number = {2},
  pages = {114-119},
  doi = {10.11648/j.ijacm.20251302.20},
  url = {https://doi.org/10.11648/j.ijacm.20251302.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20251302.20},
  abstract = {Introduction: For a patient to be deemed as American Society of Anesthesiologists (ASA) type III or IV, that patient must have a severe systemic disease that may constitute a constant threat to their daily life. Examples of these medical conditions include, but are not limited to, myocardial infarction, cerebral vascular accident, sepsis, and end-stage renal disease. For many of these patients, removal of teeth is required prior to invasive cardiothoracic procedures, in order to prevent or reduce the risk of infection, including bacterial endocarditis. The American Dental Association (ADA), along with the ASA recommend the use of deep sedation/general anesthesia in these instances. Objective: Presently, there is no leading literature comparing different anesthetic regimens that are the most commonly used and most effective for these procedures involving exodontia. The purpose of this report is to examine the most common sedative/general anesthetic regimens utilized for dentoalveolar surgery in an operating room setting, for ASA III and IV patients who require invasive cardiothoracic surgery. Methods: In this study, 54 ASA III and IV patients who required cardiothoracic surgery, underwent sedation or general anesthesia for extraction of teeth in an operating room setting 1 to 2 days prior to undergoing invasive cardiothoracic surgery. These exodontia procedures were grouped into 3 case series: under 30 minutes, 30-60 minutes, and greater than 60 minutes in duration. Conclusions: In all 3 series, midazolam, propofol, dexmedetomidine, and fentanyl were the most frequently used agents, alone or in combination. This demonstrates the fact that the sedative/anesthetic regimens utilized for dentoalveolar surgery in the operating room are similar to those utilized in outpatient oral and maxillofacial surgery settings.
},
 year = {2025}
}

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TY  - JOUR
T1  - Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting

AU  - Daniel Joseph Traub
AU  - Ethan Harris
Y1  - 2025/10/30
PY  - 2025
N1  - https://doi.org/10.11648/j.ijacm.20251302.20
DO  - 10.11648/j.ijacm.20251302.20
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 114
EP  - 119
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20251302.20
AB  - Introduction: For a patient to be deemed as American Society of Anesthesiologists (ASA) type III or IV, that patient must have a severe systemic disease that may constitute a constant threat to their daily life. Examples of these medical conditions include, but are not limited to, myocardial infarction, cerebral vascular accident, sepsis, and end-stage renal disease. For many of these patients, removal of teeth is required prior to invasive cardiothoracic procedures, in order to prevent or reduce the risk of infection, including bacterial endocarditis. The American Dental Association (ADA), along with the ASA recommend the use of deep sedation/general anesthesia in these instances. Objective: Presently, there is no leading literature comparing different anesthetic regimens that are the most commonly used and most effective for these procedures involving exodontia. The purpose of this report is to examine the most common sedative/general anesthetic regimens utilized for dentoalveolar surgery in an operating room setting, for ASA III and IV patients who require invasive cardiothoracic surgery. Methods: In this study, 54 ASA III and IV patients who required cardiothoracic surgery, underwent sedation or general anesthesia for extraction of teeth in an operating room setting 1 to 2 days prior to undergoing invasive cardiothoracic surgery. These exodontia procedures were grouped into 3 case series: under 30 minutes, 30-60 minutes, and greater than 60 minutes in duration. Conclusions: In all 3 series, midazolam, propofol, dexmedetomidine, and fentanyl were the most frequently used agents, alone or in combination. This demonstrates the fact that the sedative/anesthetic regimens utilized for dentoalveolar surgery in the operating room are similar to those utilized in outpatient oral and maxillofacial surgery settings.

VL  - 13
IS  - 2
ER  -

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Author Information

Daniel Joseph Traub

Department of Surgery, Hartford Healthcare, Hartford, United States of America

Contact Email

http://orcid.org/0009-0001-6444-8328
Ethan Harris

Restorative Dentistry, Inspire Dental of Paine, Portland, United States of America

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APA Style

Traub, D. J., Harris, E. (2025). Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting. International Journal of Anesthesia and Clinical Medicine, 13(2), 114-119. https://doi.org/10.11648/j.ijacm.20251302.20

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ACS Style

Traub, D. J.; Harris, E. Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting. Int. J. Anesth. Clin. Med. 2025, 13(2), 114-119. doi: 10.11648/j.ijacm.20251302.20

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AMA Style

Traub DJ, Harris E. Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting. Int J Anesth Clin Med. 2025;13(2):114-119. doi: 10.11648/j.ijacm.20251302.20

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@article{10.11648/j.ijacm.20251302.20,
  author = {Daniel Joseph Traub and Ethan Harris},
  title = {Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting
},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {13},
  number = {2},
  pages = {114-119},
  doi = {10.11648/j.ijacm.20251302.20},
  url = {https://doi.org/10.11648/j.ijacm.20251302.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20251302.20},
  abstract = {Introduction: For a patient to be deemed as American Society of Anesthesiologists (ASA) type III or IV, that patient must have a severe systemic disease that may constitute a constant threat to their daily life. Examples of these medical conditions include, but are not limited to, myocardial infarction, cerebral vascular accident, sepsis, and end-stage renal disease. For many of these patients, removal of teeth is required prior to invasive cardiothoracic procedures, in order to prevent or reduce the risk of infection, including bacterial endocarditis. The American Dental Association (ADA), along with the ASA recommend the use of deep sedation/general anesthesia in these instances. Objective: Presently, there is no leading literature comparing different anesthetic regimens that are the most commonly used and most effective for these procedures involving exodontia. The purpose of this report is to examine the most common sedative/general anesthetic regimens utilized for dentoalveolar surgery in an operating room setting, for ASA III and IV patients who require invasive cardiothoracic surgery. Methods: In this study, 54 ASA III and IV patients who required cardiothoracic surgery, underwent sedation or general anesthesia for extraction of teeth in an operating room setting 1 to 2 days prior to undergoing invasive cardiothoracic surgery. These exodontia procedures were grouped into 3 case series: under 30 minutes, 30-60 minutes, and greater than 60 minutes in duration. Conclusions: In all 3 series, midazolam, propofol, dexmedetomidine, and fentanyl were the most frequently used agents, alone or in combination. This demonstrates the fact that the sedative/anesthetic regimens utilized for dentoalveolar surgery in the operating room are similar to those utilized in outpatient oral and maxillofacial surgery settings.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Deep Sedation/General Anesthesia Regimens for the ASA III and IV Dental Patients in an Operating Room Setting

AU  - Daniel Joseph Traub
AU  - Ethan Harris
Y1  - 2025/10/30
PY  - 2025
N1  - https://doi.org/10.11648/j.ijacm.20251302.20
DO  - 10.11648/j.ijacm.20251302.20
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 114
EP  - 119
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20251302.20
AB  - Introduction: For a patient to be deemed as American Society of Anesthesiologists (ASA) type III or IV, that patient must have a severe systemic disease that may constitute a constant threat to their daily life. Examples of these medical conditions include, but are not limited to, myocardial infarction, cerebral vascular accident, sepsis, and end-stage renal disease. For many of these patients, removal of teeth is required prior to invasive cardiothoracic procedures, in order to prevent or reduce the risk of infection, including bacterial endocarditis. The American Dental Association (ADA), along with the ASA recommend the use of deep sedation/general anesthesia in these instances. Objective: Presently, there is no leading literature comparing different anesthetic regimens that are the most commonly used and most effective for these procedures involving exodontia. The purpose of this report is to examine the most common sedative/general anesthetic regimens utilized for dentoalveolar surgery in an operating room setting, for ASA III and IV patients who require invasive cardiothoracic surgery. Methods: In this study, 54 ASA III and IV patients who required cardiothoracic surgery, underwent sedation or general anesthesia for extraction of teeth in an operating room setting 1 to 2 days prior to undergoing invasive cardiothoracic surgery. These exodontia procedures were grouped into 3 case series: under 30 minutes, 30-60 minutes, and greater than 60 minutes in duration. Conclusions: In all 3 series, midazolam, propofol, dexmedetomidine, and fentanyl were the most frequently used agents, alone or in combination. This demonstrates the fact that the sedative/anesthetic regimens utilized for dentoalveolar surgery in the operating room are similar to those utilized in outpatient oral and maxillofacial surgery settings.

VL  - 13
IS  - 2
ER  -

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