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Propofol target-controlled infusions for sedation--a safe technique for the non-anaesthetist?
Br Dent J. 2003 Apr 26; 194(8):450-2; discussion 443.BD

Abstract

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.

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Authors+Show Affiliations

Blayney MR
Department of Anaesthesia, Noble's Isle of Man Hospital, Douglas, Isle of Man, Brisish Isles IM1 4QA. Mike.Blayney@manx.net
Ryan JD
No affiliation info available
Malins AF
No affiliation info available

MeSH

AdolescentAdultAnesthesia, DentalAnesthetics, IntravenousConscious SedationDose-Response Relationship, DrugDrug OverdoseEvaluation Studies as TopicFemaleHeart RateHumansHypnotics and SedativesInfusions, IntravenousIntraoperative ComplicationsMaleMiddle AgedPropofolRespirationRetrospective StudiesTooth ExtractionTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12778100

Citation

Blayney, M R., et al. "Propofol Target-controlled Infusions for Sedation--a Safe Technique for the Non-anaesthetist?" British Dental Journal, vol. 194, no. 8, 2003, pp. 450-2; discussion 443.
Blayney MR, Ryan JD, Malins AF. Propofol target-controlled infusions for sedation--a safe technique for the non-anaesthetist? Br Dent J. 2003;194(8):450-2; discussion 443.
Blayney, M. R., Ryan, J. D., & Malins, A. F. (2003). Propofol target-controlled infusions for sedation--a safe technique for the non-anaesthetist? British Dental Journal, 194(8), 450-2; discussion 443.
Blayney MR, Ryan JD, Malins AF. Propofol Target-controlled Infusions for Sedation--a Safe Technique for the Non-anaesthetist. Br Dent J. 2003 Apr 26;194(8):450-2; discussion 443. PubMed PMID: 12778100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Propofol target-controlled infusions for sedation--a safe technique for the non-anaesthetist? AU - Blayney,M R, AU - Ryan,J D, AU - Malins,A F, PY - 2002/06/20/received PY - 2002/10/03/accepted PY - 2003/6/5/pubmed PY - 2003/8/28/medline PY - 2003/6/5/entrez SP - 450-2; discussion 443 JF - British dental journal JO - Br Dent J VL - 194 IS - 8 N2 - 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. SN - 0007-0610 UR - https://www.unboundmedicine.com/medline/citation/12778100/Propofol_target_controlled_infusions_for_sedation__a_safe_technique_for_the_non_anaesthetist L2 - https://doi.org/10.1038/sj.bdj.4810031 DB - PRIME DP - Unbound Medicine ER -