Acceptability of intravenous propofol sedation for adolescent dental care

Abstract

Purpose Propofol is an intravenous anaesthetic agent commonly utilised in general anaesthesia, however in sub-anaesthetic concentrations can be utilised to provide sedation through automated dosing of target-controlled infusion (TCI). TCI has been shown to provide accurate and stable predicted plasma and effect-site concentrations of propofol. A four-part mixedmethod prospective study was undertaken to evaluate the safety and patient acceptability of intravenous propofol sedation in adolescent patients requiring dental care. There is a paucity in the literature on patient-reported outcomes and patient safety in the management of adolescent patients for dental treatment. Methods Demographics were recorded including age, gender, ASA Classification and Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) completed pre-operatively. Behaviour ratings of the Frankl and Houpt scales were recorded followed by post-operative questionnaire and telephone consultation. Consultation was completed following the procedure to determine patient satisfaction, memory of the procedure and any reported side effects of treatment. Qualitative thematic analysis was utilised. Results 55 patients were recruited for the study, of which 49 (mean age 14.67 years) completed the sedation study and were treated safely with no post-operative complications. The mean lowest oxygen saturation was 98.12% SpO 2 (SD 2.6). Thematic analysis demonstrated positive patient-reported outcomes to IV sedation. Conclusion Propofol TCI sedation is an effective treatment modality for the management of dentally anxious adolescents as a safe alternative to general anaesthesia, allowing the opportunity for increased provision of treatment per visit on those patients with a high dental need. Further randomised controlled trials comparing propofol TCI to other pharmacological managements are required.

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

“…Ninety-five percent of the patients reported that this technique met their needs, and 99% were completely satisfied. The satisfaction rate reported in this study was higher than that reported by Dixon et al [ 35 ] and Pourabbas et al [ 36 ].…”

Propofol's Efficacy and Outcomes on Anxious Children's Behavior in the Course of Dental Therapy

“…One of propofol's downsides, that is, the need for an expensive infusion pump, could be mitigated by administering it in this manner. [ 11 12 13 14 15 ] The conventional procedure for deep tranquility or general anesthesia in the course of oral and maxillofacial surgery is the intermittent bolus technique. Many investigations comparing intermittent bolus versus continuous infusion strategies reported no significant differences in adequate tranquility and diagnostic procedure quality.…”

“…[ 7 ] Deep tranquility's superiority over general anesthesia is supported by its advantages, which include a shorter recovery time, less patient preparation, and less monitoring equipment and skill. [ 7 ] Chloral hydrate,[ 8 ] meperidine,[ 9 ] hydroxyzine,[ 10 ] promethazine,[ 11 ] ketamine,[ 12 ] propofol,[ 13 ] and midazolam[ 14 ] have all been utilized as sedative agents in the dental therapy of pediatric patients, and each has its own set of benefits along with drawbacks. Propofol is the most commonly utilized medicine in intravenous tranquility.…”

“…A receptor is one of the mechanisms of action on the central nervous system. [ 13 ] Propofol influences the amount of neurotransmitter receptors, particularly the gamma-aminobutyric acid. Propofol's high lipophilicity safeguards a swift commencement of action, in addition to swift restructuring from the central to the peripheral compartment producing swift counterpoise of anesthetic activity.…”

Dental students’ experience of conscious sedation: A qualitative review of student reflections

“…Qualitative research is a powerful tool for exploring experience through student voice; it gives perspective and insight whilst protecting varying values, backgrounds and expectations 20,21 . Previous examination of CS education seldom employed qualitative research methods, as studies have been survey‐based, 6,9 or focussed on patients or qualified healthcare professionals 22‐27 . One useful qualitative research method is personal semi‐structured reflective logs 21,28,29 …”