Dental treatment in patients with severe gag reflex using propofol-remifentanil intravenous sedation

Shin, Soo-Il; Kim, Seung-Oh

doi:10.17245/jdapm.2017.17.1.65

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…The combination of propofol and remifentanil has been previously described for dental sedation [2][3][4], but many of these papers describe fixed-dose regimes, especially for the narcotic base. Coskun, et al, [5] described the combined use of TCI propofol and remifentanil for ovarian oocyte retrieval but used lower remifentanil target levels at the commencement than those that we utilised, in a surgical procedure expected to be far less stimulating than dental surgery.…”

Section: Discussionmentioning

confidence: 99%

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Dental Sedation: The Advantages of Propofol and Remifentanil via Target Controlled Infusions

Dg¹,

Verco²,

Woods³

et al. 2021

Int J Dent Oral Health

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We prospectively audited 150 patients undergoing dental procedures with Target Controlled Infusion (TCI) of propofol and remifentanil to evaluate patient safety, adverse effects and post-operative discharge time and patient feedback. This anaesthetic technique provides for early recovery after surgery and allows for a 92% rate of “fast track” discharge within 20 minutes (mins) of completion of surgery. The technique proved safe with 14 patients (9.3%) experiencing a total of 14 adverse events, none of which were serious and all of which were easily managed. The adverse events were 8 cases of hypoxaemia (5.3%), 3 cases of paradoxical agitation/anxiety (2.0%), 2 cases of nausea (0.01%), neither of which required treatment and 1 case of generalised body itching, again not requiring treatment. Patient feedback was unanimously positive. We compared our rate of adverse events using TCI propofol and TCI remifentanil with our previous publication of 350 patients in which we used bolus alfentanil and TCI propofol. Additionally, we compared the effect target (Cet) propofol infusion levels required between the two groups. We advocate the use of remifentanil in combination with propofol in particular for longer duration cases and for those patients at risk of developing or who manifest an intraoperative paradoxical agitation reaction.

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Section: Discussionmentioning

confidence: 99%

“…With the constant drug levels provided by the Alaris PK TCI system, a commensurately constant depth of sedation is produced. An additional advantage of the addition of remifentanil to propofol sedation is the suppression of the gag reflex [2].…”

Section: Sci Forschenmentioning

confidence: 99%

Dental Sedation: The Advantages of Propofol and Remifentanil via Target Controlled Infusions

Dg¹,

Verco²,

Woods³

et al. 2021

Int J Dent Oral Health

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“…Owing to propofol's limited analgesic properties, a higher dose of propofol is required as a single anesthetic agent to reduce pain-induced movement, which may lead to deeper level sedation and longer recovery time. Several studies have reported that combining different types of drugs has synergistic effects on drug sedative potential [ 13 14 ]. Therefore, the addition of opioid narcotics reduces the required dose of propofol significantly [ 15 16 17 ].…”

Section: Introductionmentioning

confidence: 99%

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

Lobb

Miri‐Moghaddam

Macalister³

et al. 2023

J Dent Anesth Pain Med

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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.

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“…13,14 The combination of remifentanil and propofol has a synergistic effect, which can reduce the dose of propofol to 75%, and propofol has no effect on the clearance rate of remifentanil. 15,16 This study showed that the incidence of adverse reactions such as nausea and vomiting, chills, restlessness, cough, and tachycardia was lower in the observation group than that in the control group. It suggested that the safety of remifentanil combined anesthesia is higher than that of fentanyl combined anesthesia.…”

Section: Discussionmentioning

confidence: 89%

Effect of Remifentanil Combined Anesthesia on Cytokines and Oxidative Stress in Patients undergoing Laparoscopic Surgery for Colon Cancer

Ding

Wang

et al. 2019

J Coll Physicians Surg Pak

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Dental treatment in patients with severe gag reflex using propofol-remifentanil intravenous sedation

Cited by 6 publications

References 8 publications

Dental Sedation: The Advantages of Propofol and Remifentanil via Target Controlled Infusions

Dental Sedation: The Advantages of Propofol and Remifentanil via Target Controlled Infusions

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

Effect of Remifentanil Combined Anesthesia on Cytokines and Oxidative Stress in Patients undergoing Laparoscopic Surgery for Colon Cancer

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