Comparison of the effects of target-controlled infusion-remifentanil/midazolam and manual fentanyl/midazolam administration on patient parameters in dental procedures

Abstract

Background Moderate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times. Methods In this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed. Patient indicators (pre-, intra-, and post-procedure noninvasive systolic and diastolic blood pressure, respiration, and heart rate) were compared using independent t-test analysis. Patient recovery time, procedure length, and midazolam dosage required were also compared between the two groups. Results Eighty-five patient charts were included in the final analysis: 47 received TCI-remifentanil/midazolam sedation, and 38 received manual fentanyl/midazolam sedation. Among the physiological parameters, diastolic blood pressure showed slightly higher changes in the fentanyl group (P = 0.049), respiratory rate changes showed higher changes in the fentanyl group (P = 0.032), and the average EtCO 2 was slightly higher in the remifentanil group (P = 0.041). There was no significant difference in the minimum SpO 2 levels and average procedure length between the fentanyl and remifentanil TCI pump groups (P > 0.05). However, a significant difference was observed in the time required for discharge from the chair (P = 0.048), indicating that patients who received remifentanil required less time for discharge from the chair than those who received fentanyl. The dosage of midazolam used in the fentanyl group was 0.487 mg more than that in the remifentanil group; however, the difference was not significant (P > 0.05). Conclusion The combination of TCI administered remifentanil combined with manual administered midazolam has the potential to shorten the recovery time and reduce respiration rate changes when compared to manual administration of fentanyl/midazolam. This is possibly due to either the lower midazolam dosage required with TCI remifentanil administration or achieving a stable, steady-state low dose remifentanil concentration for the duration of the procedure.

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].…”

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

“…The patients’ average recovery time was comparable to that of our previous study, where we compared the recovery time of sedated patients with midazolam coupled with bolus fentanyl and TCI remifentanil. The recovery time in this study was slightly shorter than that in both groups (18 and 13 min, respectively, for the fentanyl and remifentanil groups) [ 38 ].…”

Awareness of usage of fentanyl in dental applications among dental students

“…A small dose of even about 100 micrograms can produce an equivalent amount of analgesia that 10 mg of morphine can provide. [ 1 ] Clinically, it is most commonly used in intubated patients as a sedative and in severe pain in renal failure patients owing to its property of hepatic elimination. Sometimes, fentanyl is also prescribed in cases of severe pain among patients who have developed opioid tolerance.…”