Abstract
PurposePropofol is an intravenous anaesthetic agent commonly utilised in general anaesthesia, however in sub-anaesthetic concentrations can be utilised to provide sedation through automated dosing of target-controlled infusion (TCI). TCI has been shown to provide accurate and stable predicted plasma and effect-site concentrations of propofol. A four-part mixed-method prospective study was undertaken to evaluate the safety and patient acceptability of intravenous propofol sedation in adolescent patients requiring dental care. There is a paucity in the literature on patient-reported outcomes and patient safety in the management of adolescent patients for dental treatment.MethodsDemographics were recorded including age, gender, ASA Classification and Children’s Fear Survey Schedule—Dental Subscale (CFSS-DS) completed pre-operatively. Behaviour ratings of the Frankl and Houpt scales were recorded followed by post-operative questionnaire and telephone consultation. Consultation was completed following the procedure to determine patient satisfaction, memory of the procedure and any reported side effects of treatment. Qualitative thematic analysis was utilised.Results55 patients were recruited for the study, of which 49 (mean age 14.67 years) completed the sedation study and were treated safely with no post-operative complications. The mean lowest oxygen saturation was 98.12% SpO2 (SD 2.6). Thematic analysis demonstrated positive patient-reported outcomes to IV sedation.ConclusionPropofol TCI sedation is an effective treatment modality for the management of dentally anxious adolescents as a safe alternative to general anaesthesia, allowing the opportunity for increased provision of treatment per visit on those patients with a high dental need. Further randomised controlled trials comparing propofol TCI to other pharmacological managements are required.
Highlights
For the majority of anxious children, dental treatment can be provided using careful behavioural management, with some requiring the adjunct of conscious sedation to complete treatment
This study aimed to investigate the acceptability of intravenous sedation (IV) propofol sedation for adolescent dental care, and patientreported outcomes
This study adds to the current limited literature in reviewing IV sedation for adolescent patients requiring dental treatment
Summary
For the majority of anxious children, dental treatment can be provided using careful behavioural management, with some requiring the adjunct of conscious sedation to complete treatment. Inhalation sedation (IHS) with nitrous oxide and oxygen is the preferred technique for initial management for those who require conscious sedation under the Scottish Dental Clinical Effectiveness Program Sedation Guidelines (SDCEP 2017), with literature supporting this successful, safe and well-tolerated treatment modality from children aged 4 years (IACSD 2015; NICE 2010; EAPD 2003). In the adolescent population, success is sometimes compromised where patients present with severe dental anxiety and/or complex dental treatment (Shaw and Niven 1996) and these patients may require alternative sedation or general anaesthesia. For those adolescent patients who are anxious, it is preferable to carefully select the most. The adolescent intravenous sedation (IV) service was established to provide an alternative treatment provision to general anaesthesia for anxious adolescent patients requiring restorative and/or oral surgery care
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