Intravenous sedation for handicapped dental patients: a clinical trial of midazolam and propofol

Abstract

A double blind, cross-over study to compare intravenous sedation using continuous infusions of midazolam and propofol was carried out in 18 handicapped patients, aged between 5 and 26 years. Using a syringe pump (Ohmeda 9000) midazolam was delivered at 0.4 mg/kg/h with a bolus dose of 0.02 mg/kg and propofol was infused at 4.0 mg/kg/h with a bolus dose of 0.2 mg/kg. Sequential analysis showed that induction and recovery times were shorter with propofol (P < 0.05 and P < 0.01 respectively) and more work was performed over unit time (P < 0.05), with 15.7 units of work being completed per hour on patients under propofol sedation compared to 11.0 units under midazolam. The quality of sedation was assessed as better in patients receiving propofol; eight cases were abandoned under midazolam infusion due to failure of induction, uncontrolled movement and/or emotional outbursts compared with none under propofol. All parents/patients preferred propofol sedation, because recovery was faster and smoother.

Variation of Anesthetic Sedation Requirements in Children Undergoing Auditory Brainstem Response (ABR) Test: A Retrospective Cross-sectional Study

“…The serum levels of glutamate, an excitatory neurotransmitter, are increased in adult autistic patients [31]. Propofol potentiates the inhibition of glutamate release as described before in experimental studies [32,33] . Thus, an increase in glutamate may be expected to make autistic children in need for bigger propofol doses to achieve the desired pharmacological effect.…”

Sequential analysis applied to clinical trials in dentistry: a systematic review

“…In addition, there were some [30][31][32] split-mouth trials. The other 33,34 trials employed crossover designs. All trials except for three 23,27,32 stated that some form of randomisation was employed.…”

“…The authors acknowledge that sequential methods may not always be appropriate for all dental trials. There were eight trials 19,25,26,[30][31][32][33][34] employing graphical methods. The procedures were successful in all cases, with no trials discontinued for lack of conclusiveness.…”

“…It was found that, of the trials that used sequential analysis, six 25,[30][31][32][33][34] were fully sequential and five 18,19,22,24,28 were group sequential. The fully sequential trials were all graphical.…”

A survey of the opinions of consultant anaesthetists in Scotland of sedation carried out by dentists

“…The use of dual IV drugs and of IV propofol is widely disagreed with. It is notable that IV propofol is not licensed for use as an IV sedative agent in dentistry, although several recent studies [8][9][10][11][12][13][14][15] have outlined the benefits of propofol sedation which include rapid recovery with few side effects. The main disadvantage of propofol is that it has a much narrower margin of safety between sedation and anaesthesia than midazolam, making it dangerous for use in untrained hands.…”