Patient-Controlled Versus Anesthesiologist-Controlled Conscious Sedation with Propofol for Dental Treatment in Anxious Patients

Oei-Lim, V. L. B.; Kalkman, Cor J.; Makkes, Peter C.; Ooms, William G.

doi:10.1213/00000539-199805000-00010

Cited by 39 publications

(14 citation statements)

References 9 publications

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“…The effect of patient control on satisfaction is controversial. PCS trials where similar drug regimens were used in the experimental and control groups reported a preference for PCS [3, 20, 21] or similar satisfaction [9, 22, 23], but did not specifically address the issue of control. A meta‐analysis of PCA trials reported a significant patient preference for PCA, but no significant difference in opioid consumption, suggesting that control was important [24].…”

Section: Discussionmentioning

confidence: 99%

Effect‐site targeted patient‐controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy

2006

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SummaryPatient-controlled sedation (PCS) allows patients to match their sedation requirement to perceived discomfort. The significant delay in onset of sedation may be overcome with effect-site steered target controlled infusion, but previously only trials in volunteers have been carried out. We therefore conducted a randomised, double-blind controlled trial comparing effect-site steered propofol PCS with anaesthetist-administered propofol sedation in 40 patients presenting for colonoscopy. The initial effect-site target in the PCS group was 0.8 lg.ml )1 , increment was 0.1 lg.ml )1 and lockout was 3 min. Patient and endoscopist satisfaction and operating conditions were similar between the two groups. PCS patients were sedated more slowly (13 [7.1] vs. 3 [1.1] min; p < 0.0001) and less deeply (minimum BIS value: 71 [16] vs. 58 [15]; p = 0.13) than anaesthetist-administered propofol sedation patients. More of the latter patients were hypotensive, but all patients had similar recollection of events during the procedure and similar quality of recovery.

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Section: Discussionmentioning

confidence: 99%

Effect‐site targeted patient‐controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy

2006

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“…Oei‐Lim et al . used an initial target concentration of 2.5 µg.ml −1 and found that this resulted in oversedation in one of their 11 study patients, and found a mean target concentration of 2.7 µg.ml −1 for sedation at level 3 (all patients responded promptly to verbal command) [13]. The patient group they studied consisted of dental patients.…”

Section: Discussionmentioning

confidence: 99%

Setting targets for sedation with a target‐controlled propofol infusion

Janzen

Hall²,

Hopkins

2000

Anaesthesia

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SummaryWe studied 30 unpremedicated patients undergoing muscle biopsy under femoral nerve block to determine sedation levels reached with a Diprifusorw target-controlled propofol infusion, in order to establish the equivalent of the ED 50 for different levels of depth of sedation. Infusion was started at 0.8 mg.ml 21 and altered by increments of 0.1 mg.ml 21 after equilibrium between target and calculated concentrations, until the desired level of sedation was reached. The ED 50 target propofol concentrations for sedation at sedation levels 2 (drowsy), 3 (drowsy, responds to verbal stimulation) and 4 (responsive to physical stimulation only) were 1.0 mg.ml 21 , 1.6 mg.ml 21 and 2.1 mg.ml 21 , respectively. At sedation level 3, several patients exhibited spontaneous movement, hindering surgery. Oxygen supplementation is recommended for sedation at level 4.

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“…84 This allows patients to minimize discomfort while accounting for intrapatient pharmacodynamic differences and differing levels of tolerance of discomfort. PCS has been studied primarily in endoscopy procedures, but has also been demonstrated to be an effective sedation method in other clinical contexts, including dental, 85 ophthalmological, 86 orthopaedic, 87 gynaecological, 88 and emergency department 89 procedures. PCS during ERCP has been investigated in a number of studies and proven to be an effective method of sedation administration.…”

Section: Patient-controlled Sedationmentioning

confidence: 99%

Monitoring and delivery of sedation

Sheahan

Mathews²

2014

British Journal of Anaesthesia

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Sedation for medical procedures is provided in a variety of clinical settings by medical personnel with differing levels of education and training. Although generally a safe practice, there is a degree of morbidity and mortality associated with sedation practice. Monitoring standards continue to be refined by professional societies with the goal of improving care. The depth of sedation should be monitored with clinical criteria. Processed electroencephalographic monitors currently do not contribute significantly to sedation care. Monitoring ventilation using pulse oximetry should be abandoned for more direct methods, such as capnography-transcutaneous carbon dioxide, respiratory acoustical and thoracic impedance monitoring could also play a role. Propofol has become widely utilized for sedation, although there are concerns about its margin of safety and synergistic interactions with other agents. Dexmedetomidine and propofol/ketamine also have utility. Patient-controlled sedation pumps and target-controlled infusion devices have been developed to improve patient care and satisfaction. A computer-assisted propofol sedation device to be used by non-anaesthesiologists has been approved in the USA by the Food and Drug Administration. More computer-assisted sedation delivery devices are likely to be developed, but their clinical utility is unclear.

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Patient-Controlled Versus Anesthesiologist-Controlled Conscious Sedation with Propofol for Dental Treatment in Anxious Patients

Cited by 39 publications

References 9 publications

Effect‐site targeted patient‐controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy

Effect‐site targeted patient‐controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy

Setting targets for sedation with a target‐controlled propofol infusion

Monitoring and delivery of sedation

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