PATIENT-CONTROLLED VERSUS ANESTHESIOLOGIST-CONTROLLED CONSCIOUS SEDATION WITH PROPOFOL FOR DENTAL TREATMENT IN ANXIOUS PATIENTS

In a randomized, cross-over study, we prospectively compared the effic acy and quality of two methods to achieve conscious sedation with prop ofol in 11 unpremedicated, anxious dental patients. Each patient under went two dental procedures, one that was conducted under target-contro lled infusion (TCI) by the anesthesiologist (ACS), and the other that used patient-controlled sedation (PCS). The initial target concentrati on in the ACS mode was 2.5 mu g/mL, which was manipulated in both dire ctions until the desired clinical end point was achieved. In the PCS m ode, a 4-mg bolus of propofol (10 mg/mL) was delivered at each activat ion of the machine, infused over 7 s without a lockout interval. The a nxious dental patients could induce and maintain conscious sedation wi th the PCS settings. The mean (range) venous blood propofol concentrat ions were not significantly different with either mode: ACS 1.8 (0.8-2 .7) mu g/mL and PCS 1.2 (0.2-2.5) mu g/mL. The level of patient satisf action, quality of sedation, and treatability were not different for e ither mode of sedation. The intensity of amnesia for intraoperative ev ents was related to the blood concentrations achieved. Ln the ACS mode , one patient became unresponsive (sedation level 4) immediately after the start of sedation. No adverse cardiorespiratory effects resulted from either mode of propofol sedation. Five patients expressed a stron g preference for PCS, and three would prefer ACS in the future. The re sults of the present study suggest that with these PCS settings, a sat isfactory level of conscious sedation and a high level of patient sati sfaction was achieved. Implications: In a randomized, cross-over study , the blood propofol concentrations necessary to achieve conscious sed ation in anxious dental patients using a target-controlled infusion co nducted by the anesthesiologist versus patient-controlled sedation wer e not different. With the patient-controlled sedation settings, a sati sfactory level of conscious sedation and a high level of patient satis faction were achieved.