Safety and efficacy of target controlled infusion administration of propofol and remifentanil for moderate sedation in non-hospital dental practice

Abstract

Background Fearful and anxious patients who find dental treatment intolerable without sedative and analgesic support may benefit from moderate sedation. Target controlled infusion (TCI) pumps are superior to bolus injection in maintaining low plasma and effect-site concentration variability, resulting in stable, steady-state drug concentrations. We evaluated the safety and efficacy of moderate sedation with remifentanil and propofol using TCI pumps in non-hospital dental settings. Methods A prospective chart review was conducted on 101 patients sedated with propofol and remifentanil using TCI pumps. The charts were completed at two oral surgeons and one general dentist's office over 6 months. Hypoxia, hypotension, bradycardia, and over-sedation were considered adverse events and were collected using Tracking and Reporting Outcomes of Procedural Sedation (TROOPS). Furthermore, patient recovery time, sedation length, drug dose, and patient satisfaction questionnaires were used to measure sedation effectiveness. Results Of the 101 reviewed sedation charts, 54 were of men, and 47 were of women. The mean age of the patients was 40.5 ±18.7 years, and their mean BMI was 25.6 ± 4.4. The patients did not experience hypoxia, bradycardia, and hypotension during the 4694 min of sedation. The average minimum Mean Arterial Pressure (MAP) and heartbeats were 75.1 mmHg and 60.4 bpm, respectively. 98% of patients agreed that the sedation technique met their needs in reducing their anxiety, and 99% agreed that they were satisfied with the sedation 24 hours later. The average sedation time was 46.9 ± 55.6 min, and the average recovery time was 12.4 ± 4.4 min. Remifentanil and propofol had mean initial effect-site concentration doses of 0.96 µ/ml and 1.0 ng/ml respectively. The overall total amount of drug administered was significantly higher in longer sedation procedures compared to shorter ones, while the infusion rate decreased as the procedural stimulus decreased. Conclusion According to the results of this study, no patients experienced adverse events during sedation, and all patients were kept at a moderate sedation level for a wide range of sedation times and differing procedures. The results showed that TCI pumps are safe and effective for administering propofol and remifentanil for moderate sedation in dentistry.

Dental Sedation with Propofol-based Target Controlled Infusions: Changing Sedation Patterns and Our Current Approach after 2800 Office-based Procedures

“…Our intent is not to describe in great detail patient demographics and surgical details relating to the 2800 dental patients we have sedated in-office to date. Data of this type has been well reported by others [4,5].…”

“…We do not employ Bispectral Index (BIS) monitoring, recognising that this is a controversial area. Published studies advocating BIS use sedate patients both more [10] or less [5] than our sedation parameters. We believe that utilising our interactive, patient handholding technique obviates any need for BIS analysis.…”

Robotic Anesthesia: A Vision for 2050

“…In a very recent study of 101 patients, TCI propofol and remifentanil were used for moderately deep sedation. 23 No patient experienced any adverse events, as in loss of responsiveness or desaturation (<94% saturation). TCI was provided by 2 TCI-trained registered nurses with 1 nurse responsible for monitoring the patient in a dental clinic.…”

“…TCI was provided by 2 TCI-trained registered nurses with 1 nurse responsible for monitoring the patient in a dental clinic. 23 This shows the blessing and the curse of robots: a logical consequence of reducing anesthesiologists' workload is that they could be replaced entirely! There is therefore unlikely a single pharmacokinetic model that can be used for all patient populations, throughout the world.…”

The application of drug behavior management methods in the treatment of dental fear and oral diseases in children: A review

“…[ 40 ] Whether propofol and remifentanil are sufficiently sedated mainly depends on whether the concentration of both in the brain or the effect compartment remains stable, and the dose should be compatible with the patient and the surgical procedure. [ 41 ] To avoid causing vascular pain during the injection process, prevention can be achieved through slow injection and pre-application of lidocaine. For programmed sedation, the initial dose of propofol is slowly administered by IV injection at a dose of 0.5 to 1.0 mg/kg, and small doses of 0.5 mg/kg can be titrated every 3 to 5 minutes until the desired sedation level is achieved.…”