2004 Annual Scientific Meeting - CLICK FOR PROGRAMME

A NEW EFFECT-SITE CONTROLLED PATIENT MAINTAINED SEDATION SYSTEM IN DENTAL PATIENTS

Chapman R¹, Green J¹, Leitch J², Kenny GNC¹.

¹University Department of Anaesthesia, Glasgow Royal Infirmary, ²Glasgow Dental Hospital.

Introduction

Patient maintained sedation (PMS) involves the patient controlling their own level of sedation by operating a patient control handset (1). Previous studies with effect-site controlled Propofol patient maintained sedation (ePMS) demonstrated that patients could become oversedated if they were allowed unlimited access to the drug.The aim of this study was to assess the safety and efficacy of a new ePMS system in patients presenting for oral surgery.

Methods

Following local ethics approval forty patients were recruited. Sedation was commenced at effect-site concentration (Ce) of 1μg.ml^-1.Once the handset was enabled the patients were instructed to press the button until they felt ready to receive the dental local anaesthetic. When this was achieved the handset was taken from the patient, and the target Ce held at that level for the rest of the procedure.

Results

39 patients completed their treatment satisfactorily and maintained an adequate level of sedation (one patient had to be abandoned due to an unwillingness to proceed, this was a failure of sedation not a specific failure of the ePMS system).The mean final effect-site concentration was 1.48 (SD 0.4/Range 1.0-2.5) μg.ml^-1. There were no cases of haemodynamic instability and the mean lowest oxygen saturation was 96% (SD=2.36). No patients required emergency intervention in the form of supplementary oxygen or airway maneuvers.

Patient & surgeon scores are shown in table 1.

Discussion

The system was used successfully and treatment was completed in 39 patients. The system was found to be safe. Both surgeon and patient satisfaction were high. Although this study demonstrates the efficacy of effect-site controlled PMS, further work is required to confirm the safety of ePMS. Anaesthetic supervision is necessary until then.

Table 1. Patient and surgeon scores.

References