Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types

  • Keyling, S (Department of Dental Anesthesiology, Seoul National University, School of Dentistry) ;
  • Salmeron, Salinas (Department of Dental Anesthesiology, Seoul National University, School of Dentistry) ;
  • Kim, Hyun Jeong (Department of Dental Anesthesiology, Seoul National University, School of Dentistry) ;
  • Seo, Kwang-Suk (Department of Dental Anesthesiology, Seoul National University, School of Dentistry)
  • Received : 2019.06.01
  • Accepted : 2019.07.21
  • Published : 2019.08.30
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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 $43{\pm}18$ minutes, total sedation time was $73{\pm}23$ minutes, and total BIS values was $57{\pm}12$. The propofol maintenance dosage values for each group were: mental retardation, $3{\pm}0.5(2-4){\mu}g/ml$; autism, $3.1{\pm}0.7(2-5){\mu}g/ml;$; brain lesion, $2.8{\pm}0.7(1.5-5){\mu}g/ml;$; genetic disease, $2.9{\pm}0.9(1-4){\mu}g/ml;$ and dementia $2.3{\pm}0.7(1-3.4){\mu}g/ml;$. 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.

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References

  1. Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E. Oral health status of disabled individuals attending special schools. Eur J Dent 2010; 4: 361-6. https://doi.org/10.1055/s-0039-1697854
  2. Sakaguchi M, Higuchi H, Maeda S, Miyawaki T. Dental sedation for patients with intellectual disability: a prospective study of manual control versus bispectral index-guided target-controlled infusion of propofol. J Clin Anesth 2011; 23: 636-42. https://doi.org/10.1016/j.jclinane.2011.04.008
  3. Caputo AC. Providing deep sedation and general anesthesia for patients with special needs in the dental office-based setting. Spec Care Dentist 2009; 29: 26-30. https://doi.org/10.1111/j.1754-4505.2008.00059.x
  4. Corcuera-Flores JR, Delgado-Munoz JM, Ruiz-Villandiego JC, Maura-Solivellas I, Machuca-Portillo G. Dental treatment for handicapped patients; sedation vs general anesthesia and update of dental treatment in patients with different diseases. Med Oral Patol Oral Cir Bucal 2014; 19: e170-6.
  5. Chi SI, Kim HJ, Seo KS, Yang M, Chang J. Use of $ADMS^{TM}$ during sedation for dental treatment of an intellectually disabled patient: A case report. J Dent Anesth Pain Med 2016; 16: 217-22. https://doi.org/10.17245/jdapm.2016.16.3.217
  6. Asahi Y, Kubota K, Omichi S. Dose requirements for propofol anaesthesia for dental treatment for autistic patients compared with intellectually impaired patients. Anaesth Intensive Care 2009; 37: 70-3. https://doi.org/10.1177/0310057X0903700101
  7. Chidambaran V, Costandi A, D'Mello A. Propofol: A review of its role in pediatric anesthesia and sedation. CNS Drugs 2015; 29: 543-63. https://doi.org/10.1007/s40263-015-0259-6
  8. Lee BS, Shin TJ, Kim HJ, Choi YJ, Lee SE, Chang J, et al. Effect site concentrations of propofol for dental treatment under deep sedation in intellectually disabled patients. J Korean Dent Soc Anesthesiol 2014; 14: 167-72. https://doi.org/10.17245/jkdsa.2014.14.3.167
  9. Wang YC, Lin IH, Huang CH, Fan SZ. Dental anesthesia for patients with special needs. Acta Anaesthesiol Taiwan 2012; 50: 122-5. https://doi.org/10.1016/j.aat.2012.08.009
  10. Shin B, Yoo S, Kim J, Kim S, Kim J. A survey of dental treatment under general anesthesia in a korean university hospital pediatric dental clinic. J Dent Anesth Pain Med 2016; 16: 203-8. https://doi.org/10.17245/jdapm.2016.16.3.203
  11. Messieha Z. Risks of general anesthesia for the special needs dental patient. Spec Care Dentist 2009; 29: 21-5. https://doi.org/10.1111/j.1754-4505.2008.00058.x
  12. Morimoto Y, Hayashi M, Yokoe C, Kinugawa T, Iida T, Boku A, et al. Intravenous sedation for dental treatment in patients with intellectual disability-efficacy of nasal airway, pharyngeal suction tube and oxygen tube placement. Biomed Res (Aligarh) 2017; 28: 4931-6.
  13. Yoshikawa F, Tamaki Y, Okumura H, Miwa Z, Ishikawa M, Shimoyama K, et al. Risk factors with intravenous sedation for patients with disabilities. Anesth Prog 2013; 60: 153-61. https://doi.org/10.2344/0003-3006-60.4.153
  14. Vaessen HH, Schouten AN, van der Hoeve H, Knape JT. The feasibility of office-based propofol sedation for dental care in patients with intellectual disability by sedation practitioners. Spec Care Dentist 2017; 37: 93-8. https://doi.org/10.1111/scd.12210
  15. Mu J, Jiang T, Xu XB, Yuen VM, Irwin MG. Comparison of target-controlled infusion and manual infusion for propofol anaesthesia in children. Br J Anaesth 2018; 120: 1049-55. https://doi.org/10.1016/j.bja.2017.11.102
  16. Sheahan CG, Mathews DM. Monitoring and delivery of sedation. Br J Anaesth 2014; 113: ii37-47. https://doi.org/10.1093/bja/aeu378
  17. Saricaoglu F, Celebi N, Celik M, Aypar U. The evaluation of propofol dosage for anesthesia induction in children with cerebral palsy with bispectral index (BIS) monitoring. Paediatr Anaesth 2005; 15: 1048-52.
  18. Ouchi K, Sugiyama K. Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study. BMC Anesthesiol 2015; 15: 34. https://doi.org/10.1186/s12871-015-0006-z
  19. So E, Kim HJ, Karm MH, Seo KS, Chang J, Lee JH. A retrospective analysis of outpatient anesthesia management for dental treatment of patients with severe Alzheimer's disease. J Dent Anesth Pain Med 2017; 17: 271-80. https://doi.org/10.17245/jdapm.2017.17.4.271
  20. Patsalos PN, Froscher W, Pisani F, van Rijn CM. The importance of drug interactions in epilepsy therapy. Epilepsia 2002; 43: 365-85. https://doi.org/10.1046/j.1528-1157.2002.13001.x
  21. Johansen JW. Update on bispectral index monitoring. Best Pract Res Clin Anaesthesiol 2006; 20: 81-99. https://doi.org/10.1016/j.bpa.2005.08.004
  22. Funder KS, Steinmetz J, Rasmussen LS. Anaesthesia for the patient with dementia undergoing outpatient surgery. Curr Opin Anaesthesiol 2009; 22: 712-7. https://doi.org/10.1097/ACO.0b013e328331a4eb
  23. Alcorn S, Foo I. Perioperative management of patients with dementia. BJA Educ 2017; 17: 94-8. https://doi.org/10.1093/bjaed/mkw038

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