J Dent Anesth Pain Med.  2019 Aug;19(4):217-226. 10.17245/jdapm.2019.19.4.217.

Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types

• Salinas Salmeron KS
• Kim HJ
• Seo KS

• KMID: 2456013
• DOI: http://doi.org/10.17245/jdapm.2019.19.4.217

Abstract

BACKGROUND
We aimed to assess the dose needed to achieve the propofol effect-site concentration using target-controlled infusion in intellectually disabled patients and to detail the most effective method for achieving a safe level of consciousness without hemodynamic changes as well as detail any resulting adverse effects.
METHODS
We performed a retrospective review of sedation service records of 138 intellectually disabled patients (51, mental retardation; 36, autism; 30, brain lesion, 12 genetic diseases, 9 dementia) aged over 15 years and weighing over 30 kg. These patients had received propofol via target-controlled infusion in the special care dental clinic of Seoul National University Dental Hospital from May 2008 to September 2018 for restorative treatment (112), minor surgery (13), prosthodontics (7), periodontics treatment (5), and implant (1).
RESULTS
For all groups, the duration of dental treatments was 43 ± 18 minutes, total sedation time was 73 ± 23 minutes, and total BIS values was 57 ± 12. The propofol maintenance dosage values for each group were: mental retardation, 3 ± 0.5 (2-4) µg/ml; autism, 3.1 ± 0.7 (2-5) µg/ml; brain lesion, 2.8 ± 0.7 (1.5-5) µg/ml; genetic disease, 2.9 ± 0.9 (1-4) µg/ml; and dementia 2.3 ± 0.7 (1-3.4) µg/ml.
CONCLUSIONS
The dementia group needed a lower dosage to reach a safe, effective propofol effect-site concentration than the other groups. Since there were no complications, deep sedation is a great alternative to general anesthesia for dental treatment of intellectually disabled patients.

Keyword

Bispectral Index; Deep Sedation; Dental Treatment; Intellectual Disability; Propofol; Target Control Infusion

MeSH Terms

Anesthesia, General
Autistic Disorder
Brain
Consciousness
Deep Sedation*
Dementia
Dental Clinics
Hemodynamics
Humans
Intellectual Disability*
Methods
Minor Surgical Procedures
Periodontics
Propofol*
Prosthodontics
Retrospective Studies
Seoul
Propofol

Figure

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  Fig. 1 Population flow chart

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  Fig. 2 Propofol effect site concentration evaluation of change according time variables (Effect-site concentration (Ce)), initial Ce stands for an initial set target concentration in effect-site, Maintenance Ce means effect-site target concentration during dental treatment procedure with the patient in a state of immobilization with no side effect.

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  Fig. 3 Maintenance effect-site concentration of propofol among the groups. *: P < 0.05 post hoc LSD.

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