Effect Site Concentrations of Propofol for Dental Treatment under Deep Sedation in Intellectually Disabled Patients

Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types

“…Moreover, our study found that the propofol dose required for achieving the propofol maintenance effect-site concentration in patients in the dementia group was lower than for those in the other groups. It has been previously reported that intellectually disabled patients in the dental environment required lower doses (1.0 – 5.0 mcg/ml) to achieve effect-site concentration using titration of the target concentration than those without intellectual disabilities [8]. Another study reported that noncommunicative/nonverbal children with cerebral palsy required lower propofol doses (3.29 mg/kg) than otherwise healthy children [17] ; although, none of these studies compared the required dose between patients with different types of intellectual impairment.…”

“…Moreover, teamwork between the dentist and anesthetist is an important point to consider to successfully carrying out any procedure, and communication between both professionals is key. Moreover, for successful implementation, an individualized plan for each patient, based on their specific conditions, must be developed [8].…”

“…However, it is difficult to evaluate and maintain an adequate depth of sedation in patients with severe intellectual disability due to the different communication difficulties and sometimes may have other medical disease, for this reason these patients may be more sensitive to sedative such propofol. Therefore, because of this, the sedative dose needed for an adequate depth of sedation cannot be estimated in patients with intellectual disability, this makes sedation sometimes higher than expected, which sometimes delays the recovery, also there are probabilities of a respiratory tract obstruction and an overdose of propofol [8].…”

Deep sedation for dental treatment in a Down syndrome patient with Eisenmenger syndrome: A case report

“…Among the sedatives, the pharmacokinetic and pharmacodynamic (PK-PD) properties of propofol and remifentanil have been extensively investigated. With its favorable properties such as fast recovery, antiemetic effect, and fast titration, the use of propofol is increasing in the field of dentistry [ 14 ].…”

Use of ADMS™ during sedation for dental treatment of an intellectually disabled patient: a case report

“…In such cases, supplying oxygen during the procedure is absolutely necessary, and all available efforts must be made to monitor the patient to prevent airway obstruction or respiratory distress, including the use of carbon dioxide tension monitoring, while appropriate skills are also required to maintain the airway [ 5 ]. One of the drugs commonly used to perform deep sedation is propofol, which is known to require a lower dose in disabled patients than in normal adults [ 6 ]. Therefore, performing anesthesia depth monitoring using EEG, as with a Bispectral Index (BIS) monitor, can prevent complications associated with overdose and can be helpful in maintaining proper sedation depth [ 7 ].…”