Propofol sedation in general dental practice: the first 100 patients

Office-based ambulatory sedation--the use of the airway protector system during oral surgery: a prospective audit of the first 100 patients

PURPOSE

To evaluate the efficacy of the "Airway Protector System" (APS), a simple homemade device used for airway control during office-based dental sedation.

PATIENTS AND METHODS

A prospective audit was performed in 100 severely dental phobic patients submitted to dental treatment in a dentist office under propofol sedation.

RESULTS

Sixty-eight females and 32 males were enrolled in this study. The mean age was 45 +/- 7 years (range, 18 to 67 years). A clear airway was obtained in 94 patients. Partial airway obstruction was observed in 4 patients but manual lifting of the jaw was enough to free the partial obstruction and dental treatment was uneventfully conducted. In 2 patients, the APS had to be converted to formal nasotracheal intubation because jaw-lifting maneuvers did not adequately relieve a partial airway obstruction. Sore throat was reported in 56 patients. In 27 cases, the patients rated the complaint as severe. No patient required a chest x-ray after sedation, as there was no clinical evidence of any pulmonary complication including dyspnea, cough, or fever.

CONCLUSION

We suggest that the concomitant use of a homemade cuffed nasopharyngeal airway with continuous suction facilitates airway control during deep levels of office-based sedation for dental treatment in severely dental phobic patients.

A review of the use of propofol for procedural sedation in the emergency department

Sedation for short but potentially painful procedures is often undertaken in the emergency department. The ideal sedative regimen should provide analgesia and anxiolysis with minimal side effects and cardiorespiratory depression and rapid recovery post-procedure. Propofol has found increasing popularity with anaesthetists for sedation in the operating theatre. This is a review of the current literature looking at the use of propofol for procedural sedation in the emergency department. A comprehensive literature search of Medline from 1966 to week 4 of 2005, Embase from 1980 to week 10 of 2005, and the Cochrane Library was carried out using the OVID interface. Eight articles were selected for review. The evidence suggests that propofol is both effective and safe to use in the emergency department. However, several of the papers reviewed used deep levels of sedation that are not recommended in the UK by non-anaesthetists.

Propofol intravenous conscious sedation for anxious children in a specialist paediatric dentistry unit

OBJECTIVES

To report on both the use and dosage of propofol, as a new intravenous (IV) conscious sedative agent, for anxious children referred to a specialist paediatric dentistry service.

SETTING

Paediatric Dentistry Unit, Glasgow Dental Hospital and School.

SAMPLE

Thirty-four children, 25 females and 9 males, mean age 12 years 10 months, with a mean weight of 54.6 kg (range 30-110 kg).

METHODS

Report from 34 patients receiving intravenous sedation for the first time in respect of weight dose and amount of treatment completed.

RESULTS

Thirty-two children successfully accepted operative dental care on their first visit, they received a mean total dose of 146.25 mg of propofol (range 10 mg to 356 mg); in relation to body weight, the mean was 2.5 mg/kg (range 0.2-5.4 mg/kg). The treatment that they received included fissure sealants, amalgam and adhesive restorations, root canal therapy and single and multiple extractions. Their sedation and recovery were uneventful.

CONCLUSIONS

Sub-anaesthetic doses of propofol used for IV conscious sedation infusion facilitated operative dental treatment in anxious children.

Propofol target-controlled infusions for sedation--a safe technique for the non-anaesthetist?

OBJECTIVE

As an alternative to general anaesthesia for dentistry.attention has been focused on other, apparently safer, methods of pain and anxiety control. We have undertaken a study to evaluate the safety and efficacy of intravenous sedation using propofol target-controlled infusions.

DESIGN

We describe a retrospective observational analysis of propofol conscious sedation as an adjunct to local anaesthesia for patients undergoing simple or surgical exodontia. All the patients were assessed,selected and treated according to standardized hospital sedation protocols. Experienced anaesthetists used a standard regimen, with ECG, pulse oximetry and non-invasive blood pressure monitoring. A standard sedation record was completed for each patient. The initial target plasma propofol concentration was set at 1.5 microg ml(-1), adjusted thereafter to achieve the desired level of sedation. Any adverse events were recorded.

SETTING

Birmingham Dental Hospital.

SUBJECTS

Three hundred consecutive sedation episodes in adult dental phobic patients requiring exodontia under local anaesthesia.

RESULTS

Sedation and treatment were satisfactorily completed in 297 patients. The mean target propofol concentration required was 2.1 microg ml(-1), (SD = 0.47 microg ml(-1), range 1 - 4 microg ml(-1)). General anaesthesia occurred in two cases (target concentration (TC) 2 microg ml(-1)), over sedation in 11 cases(TC 1 - 3 microg ml(-1)), and transient hypoxaemia in 7 cases (TC 1.8 - 2.5 microg ml(-1)).

CONCLUSION

Intravenous sedation with target-controlled propofol infusions is effective. However, significant adverse effects may occur at target concentrations below 2.1 microg ml(-1). Only anaesthetists working in an appropriate environment should practise this technique.