Background: Succinic semialdehyde dehydrogenase (SSADH) deficiency is a common inborn error of GABA
metabolism characterized by accumulation of neurotoxic metabolites and manifesting as seizures, motor delays,
hypotonia, and behavioral disturbances. Surgical interventions pose heightened anesthetic risks, especially
under general anesthesia, due to altered neuromuscular responses, seizure susceptibility, and metabolic
instabilities.
Patient: In this case of a 21-year-old woman, she was diagnosed with SSADH deficiency as a child and afterwards
experienced frequent epileptic seizures, delays in motor skills and odd behavioral traits. A patient has toothache
and swelling over her right lower second premolar along with a cystic tumor. Coordinating several medical
specialties, the surgeons chose to use conscious sedation with both midazolam and ketamine at 0.5 mg/kg each.
They also added local infiltration by using 4% articaine and added 1 per 100,000 epinephrine. We kept an eye on
vital signs while making sure that the patient was always receiving the correct amount of supplementary oxygen.
After sectioning the tooth, it was removed smoothly, a cyst was removed and the area was closed using resorbable
stitches. No seizures happened during or after surgery, no breathing difficulties or unwanted side effects,
complications or problems in blood circulation were detected. While undergoing surgery and after everything was
finished, the patient did not have any seizures and recovered well.
Conclusion: This case showed that if we administer ketamine-midazolam for conscious sedation along with its
protocol and local anesthesia with prolonged action, it is efficient in dental surgery in patients who have SAADH
deficiency because it showed no postoperative seizures and no complications were observed. It minimised the
risk of undesirable events during or after the surgical procedure.