Dental Sedation: The Advantages of Propofol and Remifentanil via Target Controlled Infusions

Abstract

We prospectively audited 150 patients undergoing dental procedures with Target Controlled Infusion (TCI) of propofol and remifentanil to evaluate patient safety, adverse effects and post-operative discharge time and patient feedback. This anaesthetic technique provides for early recovery after surgery and allows for a 92% rate of “fast track” discharge within 20 minutes (mins) of completion of surgery. The technique proved safe with 14 patients (9.3%) experiencing a total of 14 adverse events, none of which were serious and all of which were easily managed. The adverse events were 8 cases of hypoxaemia (5.3%), 3 cases of paradoxical agitation/anxiety (2.0%), 2 cases of nausea (0.01%), neither of which required treatment and 1 case of generalised body itching, again not requiring treatment. Patient feedback was unanimously positive. We compared our rate of adverse events using TCI propofol and TCI remifentanil with our previous publication of 350 patients in which we used bolus alfentanil and TCI propofol. Additionally, we compared the effect target (Cet) propofol infusion levels required between the two groups. We advocate the use of remifentanil in combination with propofol in particular for longer duration cases and for those patients at risk of developing or who manifest an intraoperative paradoxical agitation reaction.