Neurosedation in dentistry of the disabled patient: the use of midazolam, propofol, and remifentanil.
OBJECTIVE
This prospective randomized study, deals with neurosedation in dental treatment of 200 disabled patients and unable to cooperate, subdivided in 4 groups of 50 male only patients, with age ranging from 28 to 59 (39+/-11), ASA I-III.


METHODS
The pharmaceuticals used were Midazolam (group MID) Propofol (group Prop) and Remifentanil. Midazolam and Propofol were used following a bolus-infusion sequence, both separately and in combination among themselves (MID\PROP group), or with an opioid, Remifentanil (MID\PROP\REMI group). ECG, heart rate , non invasive blood pressure (NIBP), SaO(2), EtCO(2) during the procedure were monitored. Induction time, duration of the sedation, recovery time and discharge were reported.


RESULTS
The statistical analysis demonstrated the superiority of the PROP group for induction time in minute (3.1+/-0.5) in comparison with the MID group (10.6+/-2.1), the MID\PROP group (4.3+/-1.3) and MID\PROP\REMI (3.7+/-1.2). The recovery and discharge times have confirmed the superiority of the MID\PROP\REMI group in comparison with the other 3 groups.


CONCLUSIONS
This combination proved best at leveraging the synergistic characteristics of each single pharmaceutical and minimizing the collateral effects of each individually.
Department of Anesthesia and Resuscitation, 2nd Faculty of Medicine and Surgery, La Sapienza University, Rome, Italy.
S
S
Collini
G
G
Pinto
L
L
Lejeune
S
S
Di Carlo
S
S
Meloncelli
G
G
Barraco
R
R
Gatto
D000328:Adult; D016292:Procedural Sedation / Q000379:methods; D016854:Dental Anxiety / Q000628:therapy; D003757:Dental Implantation; D006233:Persons with Disabilities; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007570:Jaw Cysts / Q000601:surgery; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009910:Oral Hygiene; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000628:therapy; D000077208:Remifentanil; D012390:Root Canal Therapy; D014081:Tooth Extraction; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam; D015742:Propofol