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

Abstract

Background We aimed to assess the dose needed to achieve the propofol effect-site concentration using target-controlled infusion in intellectually disabled patients and to detail the most effective method for achieving a safe level of consciousness without hemodynamic changes as well as detail any resulting adverse effects. Methods We performed a retrospective review of sedation service records of 138 intellectually disabled patients (51, mental retardation; 36, autism; 30, brain lesion, 12 genetic diseases, 9 dementia) aged over 15 years and weighing over 30 kg. These patients had received propofol via target-controlled infusion in the special care dental clinic of Seoul National University Dental Hospital from May 2008 to September 2018 for restorative treatment (112), minor surgery (13), prosthodontics (7), periodontics treatment (5), and implant (1). Results For all groups, the duration of dental treatments was 43 ± 18 minutes, total sedation time was 73 ± 23 minutes, and total BIS values was 57 ± 12. The propofol maintenance dosage values for each group were: mental retardation, 3 ± 0.5 (2–4) µg/ml; autism, 3.1 ± 0.7 (2–5) µg/ml; brain lesion, 2.8 ± 0.7 (1.5–5) µg/ml; genetic disease, 2.9 ± 0.9 (1–4) µg/ml; and dementia 2.3 ± 0.7 (1–3.4) µg/ml. Conclusions The dementia group needed a lower dosage to reach a safe, effective propofol effect-site concentration than the other groups. Since there were no complications, deep sedation is a great alternative to general anesthesia for dental treatment of intellectually disabled patients.

Effectiveness and Safety of Intravenous Sedation with Propofol in Non-Operating Room Anesthesia (NORA) for Dental Treatment in Uncooperative Paediatric Patients

“…In fact, hypotension with initial Propofol bolus is a temporary and predictable event that is more frequent in patients with special medical condition [23]. As these patients experience stressful situations in a more accentuated way, it is necessary a close collaboration between dentists and anesthetists to draw up a tailored therapeutic plan [25].…”

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

“…All patients received 3–5 L/min of supplemental O 2 via a nasal cannula supplied by nasal prongs [ 16 ]. Capnography was performed and monitored using side-stream nasal prongs (Masimo Root Monitor, Masimo, California, USA).…”

Analysis of behavioral management for dental treatment in patients with dementia using the Korean National Health Insurance data

“…When using propofol in patients with dementia, it is difficult to use a lower concentration than in patients with other disabilities [ 21 ]. The use of dexmedetomidine in patients with dementia has also been reported to take a long time to recover, and complications such as hypoxia (SpO 2 <94%) 35%, apnea 7%, airway obstruction 5% irrespective of the drug (propofol, midazolam, and dexmedetomidine) have also been reported [ 6 ].…”