Propofol-remifentanil TCI sedation for oral surgery

To investigate the safety and efficacy of a propofol-remifentanil target controlled infusion (TCI) sedation technique for oral surgery.

This prospective study involved patient and registered nurse (RN) questionnaires to assess the efficacy of sedation during surgery. Outpatients having dental extractions in a private office-based practice with TCI sedation were monitored with a Sleep Apnoea Monitor (SAM) to measure the number of Oxygen Desaturation Events (ODEs), defined as a drop in blood oxygenation to below 94%.

Patient- and RN-assessed questionnaires showed a high standard of perceived sedation efficacy, independent of patient BMI. The proportion of patients having one or more ODEs was greater in higher BMI categories: underweight (20.0%), normal (47.9%), overweight (68.2%) and obese (81.8%). The odds of at least one ODE was estimated to be 1.2 times greater for each unit increase in BMI (OR 1.2; 95% CI 1.1-1.3), and at a fixed BMI, the odds of at least one ODE was estimated to be 2.6 times as great for a male as a female (OR 2.6; 95% CI 1.2-5.52). Age, patient nervousness and American Society of Anesthesiologists (ASA) classification were not associated with ODEs.

The TCI technique had a high standard of efficacy, and there were no adverse safety outcomes. Higher BMI and male sex were found to be independently associated with predictors of ODEs during oral surgery under propofol-remifentanil TCI sedation.