Pharmacological Agents and Drug Safety in Oral and Maxillofacial Surgery Anaesthesia

Oral and maxillofacial surgery; Anaesthetic pharmacology; Drug safety; Local anaesthetic systemic toxicity; Multimodal analgesia.

Sneha S Kulkarni1*
Assistant Professor, Department of Chemistry, KLS
Vishwanathrao Deshpande Institute of Technology,
Haliyal 581329, Uttara Kannada, Karnataka.
ORCID ID: https://orcid.org/0000-0003-0753-1237
Email ID: snehakulkarni721@gmail.com

Dr. Vignan Narpati 2
Senior Resident, Specialization: pharmacology
Department Of Pharmacology , Sunderlal Patwa
Medical College, Mandsaur, MP, 458001 ORCID
ID:
0009-0007-4511-625X
Email
ID:
vignan.doc@gmail.com

Dr. Pratima Singh3
Assitant Professor, Department of Anaesthesiology,
Kanti Devi Medical College Hospital and Research
Centre, Akbarpur, Chhata, Mathura Specialization:
MBBS DA DNB ORCID ID: 0009-0009-5413-3718
Email ID: pratima.singh242@gmail.com
Nerella Srimannarayana4,
Professor, Department of Mathematics,, Koneru
Lakshmaiah Education Foundation, Vaddeswaram,
Guntur(Dt.,), Andhra Pradesh, India, PIN: 522502,
Specialization: Graph Theory, Special Functions
and Differential Equations and Modelling of
Mathematics. ORCID ID : 0000-0003-4982-5073,
Email ID : sriman72@gmail.com
Saumya Srivastava5
Associate Professor, Department of Physiotherapy,
Nitte (Deemed to be University), Nitte Institute of
Physiotherapy (NIPT), Mangalore, India.
Specialization: Orthopedic and Manual therapy
ORCID ID: 0000-0001-7059-6004Email ID:
saumyasri2000@nitte.edu.in
Dr Vikash Kumar Jha6
Senior Lecturer, Department of Oral Medicine &
Radiology, KIIT University, Bhubhneswar, 751024
Specialization - Oral Medicine & Radiology
ORCID ID- 0000 000307264829Email IDjha.vikash980@gmail.com
Divyam Saxena7
Lecturer,
Department
of
Pharmacology,
Specialization:
Pharmacology
Teerthanker
Mahaveer College of Pharmacy, Teerthanker
Mahaveer University, Moradabad-244001, Uttar
Pradesh, India ORCID ID: https://orcid.org/00090002-0948-0648
Email
ID:
divyamsaxena321@gmail.com

Received: 10.03.2026
Accepted: 06.04.2026

European Journal of Prosthodontics and Restorative Dentistry (2026) 34 (2), 19–28

Pharmacological Agents and
Drug Safety in Oral and
Maxillofacial
Surgery
Anaesthesia
----------------------------------------------------------------Abstract
Safe and effective anaesthesia is integral to modern oral and maxillofacial
surgery (OMFS), particularly with the growing shift toward office-based
and ambulatory procedures. This narrative review critically evaluates the
pharmacological agents used in OMFS anaesthesia and examines associated
safety considerations, adverse reactions, and evolving clinical strategies.
Cumulative evidence on local anaesthetics, sedative-hypnotics, general
anaesthetic agents, neuromuscular blockers, opioids and multimodal
analgesic strategies were evaluated based on evidence accumulated through
clinical trials, observational studies and professional implications. Local
anaesthetic agents continue to be the basis of pain management during the
perioperative period but care should be taken to prevent and treat the local
anaesthetic systemic toxicity (LAST). Modern care focuses on early
warning, mechanization of airways, control of seizures, and lipid emulsion.
The benzodiazepines, propofol, dexmedetomidine, ketamine and
inhalational agents are effective but require close titration and maintenance
of respiratory and cardiovascular parameters to prevent such adverse effects
as hypoventilation, hypotension, residual paralysis and hypersensitivity.
Growing attention to multimodal, opioid-sparing analgesia has enhanced
the level of safety in the postoperative period by decreasing the risk of
respiratory depression and opioid dependence. Improved standards of
monitoring especially the use of capnography in moderate and deep sedation
has improved early signs of respiratory compromise in ambulatory
environments. Special population considerations, comprehensive
preoperative risk stratification, and structured emergency preparedness
protocols are essential for minimizing preventable complications. Emerging
innovations including remimazolam sedation, liposomal local anaesthetics,
and ultrasound-guided techniques offer additional opportunities to enhance
safety when integrated within evidence-based frameworks.
1. Introduction
Oral and maxillofacial surgery (OMFS) in the current day engages the need
of safe and efficient anesthesia to carry out procedures as simple as
dentoalveolar extractions, to as severe as orthognathic, trauma, oncologic,
and reconstructive surgery. The shift towards office-based anesthesia and
ambulatory care of the surgical care has brought about the need to be very
efficient and cost effective and also access the care; however, it has also
brought about the need to attain a high degree of pharmacological safety
and well defined practices in the perioperative practice, etc. The clinical
evidence in large scale indicates that though anesthesia induced adverse
events in OMFS are rather small, respiratory and cardiovascular
complications remain in the outpatient environment [1]. These findings
reinforce the importance of having a well-structured monitoring system,
standardized clinical pathways and constant quality improvement programs
that attempt to minimize morbidity that is preventable.
The required guideline is provided by guidelines on safe practice in sedation
and anesthesia. New guidelines of procedural sedation underline the
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