The safety and efficacy of IV sedation using propofol target-controlled infusions

Abstract

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. Design 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 15 mg ml−1, adjusted thereafter to achieve the desired level of sedation. Any adverse events were recorded. Setting Birmingham Dental Hospital. Subjects 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 21 mg ml−1 (SD = 047 mg ml−1, range 1–4 mg ml−1). General anaesthesia occurred in two cases (target concentration (TC) 2 mg ml−1), over sedation in 11 cases (TC – 3 mg ml−1), and transient hypoxaemia in 7 cases (TC 18 – 25 mg ml−1). Conclusion Intravenous sedation with target-controlled propofol infusions is effective. However, significant adverse effects may occur at target concentrations below 21 mg ml−1. Only anaesthetists working in an appropriate environment should practise this technique.