Propofol target-controlled infusions for sedation--a safe technique for the non-anaesthetist?
OBJECTIVE
As an alternative to general anaesthesia for dentistry.attention has been focused on other, apparently safer, methods of pain and anxiety control. We have undertaken a study to evaluate the safety and efficacy of intravenous sedation using propofol target-controlled infusions.


METHODS
We describe a retrospective observational analysis of propofol conscious sedation as an adjunct to local anaesthesia for patients undergoing simple or surgical exodontia. All the patients were assessed,selected and treated according to standardized hospital sedation protocols. Experienced anaesthetists used a standard regimen, with ECG, pulse oximetry and non-invasive blood pressure monitoring. A standard sedation record was completed for each patient. The initial target plasma propofol concentration was set at 1.5 microg ml(-1), adjusted thereafter to achieve the desired level of sedation. Any adverse events were recorded.


METHODS
Birmingham Dental Hospital.


METHODS
Three hundred consecutive sedation episodes in adult dental phobic patients requiring exodontia under local anaesthesia.


RESULTS
Sedation and treatment were satisfactorily completed in 297 patients. The mean target propofol concentration required was 2.1 microg ml(-1), (SD = 0.47 microg ml(-1), range 1 - 4 microg ml(-1)). General anaesthesia occurred in two cases (target concentration (TC) 2 microg ml(-1)), over sedation in 11 cases(TC 1 - 3 microg ml(-1)), and transient hypoxaemia in 7 cases (TC 1.8 - 2.5 microg ml(-1)).


CONCLUSIONS
Intravenous sedation with target-controlled propofol infusions is effective. However, significant adverse effects may occur at target concentrations below 2.1 microg ml(-1). Only anaesthetists working in an appropriate environment should practise this technique.
Blayney
M R
MR
Department of Anaesthesia, Noble's Isle of Man Hospital, Douglas, Isle of Man, Brisish Isles IM1 4QA. Mike.Blayney@manx.net
Ryan
J D
JD
Malins
A F
AF
D000293:Adolescent; D000328:Adult; D000766:Anesthesia, Dental / Q000592:standards*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose; D005069:Evaluation Studies as Topic; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D012119:Respiration / Q000187:drug effects; D012189:Retrospective Studies; D014081:Tooth Extraction; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D015742:Propofol