No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Propofol An Overview of Its Risks and Benefits.
Abstract
With little room for error and recent reports of abuse and deaths, propofol, a commonly used general anesthetic induction agent, has provoked considerable concern and has stirred debate regarding its classification and how care should be rendered. The drug, when abused, presents a risk for psychological dependence, and studies have indicated an increase in the rate of propofol abuse, particularly among individuals in academic anesthesia programs. When used for sedation, propofol can pose significant risks for cardiac and respiratory complications, making it crucial that the administration of this drug be provided by a practitioner who is well trained in general anesthesia. With an attractive pharmacokinetic profile of rapid onset and offset, propofol has a place in medical and dental care. When determining whether to administer propofol to patients, practitioners should bear in mind certain precluding factors, such as allergies to egg and soy. The narrow margin for error, the lack of a reversal agent, and risk for death make diligent and vigilant care imperative.
... It is also possible to prescribe opioids for ambulatorial use, although with some more caution. For deep sedation, the drugs used are propofol and the neuroleptics, but these medications should be used in a hospital setting [14]. Table 3 shows the different types of medication that may be used in an outpatient setting by the dentist in order to perform mild and / or moderate sedation for implementing dental treatment. ...
... Table 3 shows the different types of medication that may be used in an outpatient setting by the dentist in order to perform mild and / or moderate sedation for implementing dental treatment. The table also presents the side effects of each sedative [12,14]. ...
... Many patients are collaborative even though they are not able to carry out interactive communication with the dentist because their special conditions; -Sedation Technic: For patients in category 2 (Tables 1 and 2) [9,10], and in cases of failure in the use physical support techniques, the dentist may use ambulatory care with sedation [26]. Selecting the most appropriate drug for sedation should take into consideration the dental need, the underlying disease of the patient, and the advantages and disadvantages of using each of them (Table 3) [12,14]. The outpatient sedation technique should only be performed by qualified professionals. ...
... It is also possible to prescribe opioids for ambulatorial use, although with some more caution. For deep sedation, the drugs used are propofol and the neuroleptics, but these medications should be used in a hospital setting [14]. Table 3 shows the different types of medication that may be used in an outpatient setting by the dentist in order to perform mild and / or moderate sedation for implementing dental treatment. ...
... Table 3 shows the different types of medication that may be used in an outpatient setting by the dentist in order to perform mild and / or moderate sedation for implementing dental treatment. The table also presents the side effects of each sedative [12,14]. ...
... Many patients are collaborative even though they are not able to carry out interactive communication with the dentist because their special conditions; -Sedation Technic: For patients in category 2 (Tables 1 and 2) [9,10], and in cases of failure in the use physical support techniques, the dentist may use ambulatory care with sedation [26]. Selecting the most appropriate drug for sedation should take into consideration the dental need, the underlying disease of the patient, and the advantages and disadvantages of using each of them (Table 3) [12,14]. The outpatient sedation technique should only be performed by qualified professionals. ...
... Research has linked individual psychological profiles, cultural influences, and prior bad experiences to the development of DA (133)(134)(135)(136)(137)(138)(139)(140)(141)(142). The Corah Dental Anxiety Scale (CDAS) and the Modified Dental Anxiety Scale (MDAS) are two scales available to determine the severity of DA, which is why their examination is so critical (143)(144)(145)(146)(147)(148)(149)(150)(151)(152)(153)(154). These instruments allow dentists to assess patients' anxiety levels, which makes it easier to use the proper management techniques (155)(156)(157)(158)(159)(160). ...
Dental anxiety (DA), a common problem with essential ramifications for dental treatment, is thoroughly examined in this paper. The historical background of dental pain and anxiety management, the physiological and psychological aspects of anxiety, and current management techniques are all covered in the analysis. Pharmacological therapies (local anesthetics and anxiolytics), iatrosedative tactics (communication and reassurance), and hypnotic procedures (creating a state of calm and suggestibility) are given special attention. To improve patient satisfaction and guarantee efficient and kind dental care, the book emphasizes the significance of a multimodal approach to DA control that combines behavioral and pharmacological approaches. It draws attention to the necessity of a patient-centered strategy that considers the limitations of pharmaceutical treatments and encourages compassionate dialogue and the development of trust between the patient and the dentist.
... Therefore, the US Food and Drug Administration states that propofol should be administered by a skilled anesthesiologist, whose attention is solely focused on monitoring the patient and administering the medication during the procedure. 4 Dixon et al. 5 reported that 49 children who underwent dental treatment with intravenous sedation using propofol completed the treatment without complications. They concluded that propofol can be used as a safe medication for sedation during paediatric dental procedures. ...
Background
Planning the extent of paediatric dental treatment under deep sedation is highly important, as the duration of the sedation should be limited to approximately 1 h, and the amount of local anesthesia is limited by the children's body weight.
Aim
To compare treatment plans estimated at initial examinations with actual dental treatments under intravenous deep sedation. We examined factors that could affect the differences.
Design
For this retrospective cohort study, data were collected from the medical records of all the children younger than 18 years who underwent dental treatment under intravenous deep sedation during 2019–2021 at the Department of Pediatric Dentistry.
Results
In total, 108 children were included. During the actual versus the estimated treatment under deep sedation, more teeth were treated ( p < .001), and the treatment was more complex ( p < .001). A longer waiting period for dental treatment was found to be correlated with a greater number of treated teeth than was estimated ( p = .003) and with greater complexity of the actual than the estimated treatment ( p = .003).
Conclusion
Actual compared with estimated dental treatment under deep sedation involved more teeth and was of greater complexity. This suggests that referrals should include children with limited estimated treatment plans.
... The mechanism of action of propofol is related to the interaction of specific structures on the postsynaptic membrane. Extensive experiments have shown that inhibitory central GABAergic neurotransmission is the key to mediating the pharmacological effects of propofol (Trapani et al., 2000;Saraghi et al., 2013). GABA is an important inhibitory neurotransmitter in the central nervous system, and its effects are produced by selective interaction of GABA receptors (GABAA and GABAB) that are widely distributed in immune cells such as neutrophils, monocytes and macrophages (Bhat et al., 2010). ...
Macrophages work with monocytes and dendritic cells to form a monocyte immune system, which constitutes a powerful cornerstone of the immune system with their powerful antigen presentation and phagocytosis. Macrophages play an essential role in infection, inflammation, tumors and other pathological conditions, but these cells also have non-immune functions, such as regulating lipid metabolism and maintaining homeostasis. Propofol is a commonly used intravenous anesthetic in the clinic. Propofol has sedative, hypnotic, anti-inflammatory and anti-oxidation effects, and it participates in the body’s immunity. The regulation of propofol on immune cells, especially macrophages, has a profound effect on the occurrence and development of human diseases. We summarized the effects of propofol on macrophage migration, recruitment, differentiation, polarization, and pyroptosis, and the regulation of these propofol-regulated macrophage functions in inflammation, infection, tumor, and organ reperfusion injury. The influence of propofol on pathology and prognosis via macrophage regulation is also discussed. A better understanding of the effects of propofol on macrophage activation and function in human diseases will provide a new strategy for the application of clinical narcotic drugs and the treatment of diseases.
... The dosage given is between 1-1.5 mg/ kg of body weight and followed by maintenance dose rang- ing from 0.3 to 4 mg/kg/body weight [8,16]. Care should be taken when using it for sedation, as they show significant risks for cardiac and respiratory complications, making it crucial that the administration of this drug be provided by a practitioner who is well trained in general anesthesia [17]. ...
... Patients with a high level of fear who probably do not seek dental care on a regular basis. Moderate levels of fear and anxiety are able to tolerate minor dental treatment but having a higher level of anxiety for more involved treatment administered under general anesthesia of dental procedures have shown the reduction of patient pain and anxiety [4]. Generally, some patients cannot be treated with local anesthesia alone for various reasons due to behavioral problems resulting from some form of disability. ...
Fear or anxiety towards dental procedures can discourage patients from getting dental treatment done. The management of anxious patients undergoing dental treatment is still a challenge in clinical practices. The increased use of sedative and hypnotics in dental practices appears to indicate that the assessment of dental student’s awareness of it, is essential. This survey is carried out to determine the awareness of sedatives and hypnotics used in dental practices among dental students. A questionnaire-based survey study was conducted among 100 undergraduate students at Saveetha Dental College and hospital. The study revealed 94% of the students are aware of the commonly used sedatives and hypnotics in dental practices.
... Some hospitals are routinely utilizing 2,6-diisopropylphenol (propofol) with a benzodiazepine, ketamine or fentanyl during conscious sedation during both ambulatory surgery and inpatient surgery for appropriate elderly patients [35][36][37][38][39]. Propofol when used in conjunction with fentanyl appears to be a safe, quick, and effective method of providing conscious sedation which is advantageous for the elderly, especially during spinal and neurological blocks in the effort to avoid general anesthesia [35]. Propofol has an attractive pharmacokinetic profile of rapid onset and offset, but must be employed with caution for patients with cardiac and respiratory complications and when egg and soy allergies are present [40]. Propofol in combination with benzodiazepines such as flurazepam facilitates GABA receptor activity and increases the apparent GABAA receptor complex affinity for propofol, resulting in a synergistic potentiation by the combination [41]. ...
... However, in some cases requiring very complex dental procedures, or if the patient is in poor condition, conscious sedation may be inadvisable or the class of drugs used may be contraindicated. The adverse effects associated with conscious sedation are a result of the class of drugs used, with hallucinations being the most frequently observed adverse reaction (4,5) linked to the use of benzodiazepines, propofol and nitrous oxide. Nitrous oxide may also cause damage to immune and hematologic systems, and it can cause fertility problems in women (6)(7)(8)(9). ...
Objective:
The main objective of this systematic literature review is to identify the safest and most effective sedative drugs so as to ensure successful sedation with as few complications as possible.
Study design:
A systematic literature review of the PubMed MEDLINE database was carried out using the key words "conscious sedation," "drugs," and "dentistry." A total of 1,827 scientific articles were found, and these were narrowed down to 473 articles after applying inclusion and exclusion criteria. These 473 studies were then individually assessed for their suitability for inclusion in this literature review.
Results:
A total of 21 studies were selected due to their rigorous study design and conduciveness to further, more exhaustive analysis. The selected studies included a total of 1,0003 patients classified as ASA I or II. Midazolam was the drug most frequently used for successful sedation in dental surgical procedures. Ketamine also proved very useful when administered intranasally, although some side effects were observed when delivered via other routes of administration. Both propofol and nitrous oxide (N2O) are also effective sedative drugs.
Conclusions:
Midazolam is the drug most commonly used to induce moderate sedation in dental surgical procedures, and it is also very safe. Other sedative drugs like ketamine, dexmedetomidine and propofol have also been proven safe and effective; however, further comparative clinical studies are needed to better demonstrate which of these are the safest and most effective.
... Propofol (2,6-diisopropylphenol) is an intravenous anesthetic agent that has been widely administered as a short-acting intravenous anesthetic since the late 1980s (6). In addition to its application for maintenance of sedative effects as an anesthetic, various characteristics of propofol have been investigated in recent years. ...
Parkinson's disease (PD) is a progressive and degenerative disorder of the central nervous system, characterized by the loss of dopaminergic neurons and muscular rigidity. Treatment with propofol (2,6‑diisopropylphenol) has been observed to attenuate oxidative stress injury via inhibition of programmed cell death. Results from the present study indicate that propofol treatment attenuates 1‑methyl‑4‑phenylpyridinium (MPP+)‑induced oxidative stress, which was demonstrated by increased levels of reactive oxygen species, 4‑hydroxy‑2‑nonenal and protein carbonyls. Furthermore, it was demonstrated that propofol may ameliorate MPP+‑induced mitochondrial dysfunction by increasing the level of ATP and the mitochondrial membrane potential. MTT and lactate dehydrogenase assays indicated that propofol treatment reduces cell vulnerability to MPP+‑induced insult. Propofol was also observed to prevent apoptotic signals by reducing the ratio of Bcl‑2‑associated X protein to B‑cell lymphoma 2, reducing the expression level of cleaved caspase‑3 and attenuating cytochrome c release. Thus, propofol may present as a novel therapeutic strategy for the treatment of PD.
... 5,[26][27][28][29] The risks to the practitioner may relate to potential accusations arising from vivid hallucinations that patients often experience. 30,31 This phenomenon is a side effect of the benzodiazepines, propofol and also nitrous oxide, which may be used to provide "relative analgesia" (RA). Patients should be advised of this side effect as part of the preoperative informed consent process. ...
Throughout the world there is considerable variation in the techniques used to manage anxious dental patients requiring treatment. Traditionally anxious or phobic dental patients may have been sent for general anaesthesia to allow dental treatment be undertaken. While this is still the case for the more invasive oral surgical procedures, such as wisdom teeth extraction, sedation in general dentistry is becoming more popular. Various sedation techniques using many different anaesthetic agents have gained considerable popularity over the past 30 years. While the practice of sedating patients for dental procedures is invaluable in the management of suitably assessed patients, patient safety must always be the primary concern. Medical, dental and psychosocial considerations must be taken into account when evaluating the patient need and the patient suitability for sedation or general anaesthesia. The regulations that govern the practice of dental sedation vary throughout the world, in particular regarding the techniques used and the training necessary for dental practitioners to sedate patients. It is necessary for medical and dental practitioners to be up to date on current practice to ensure standards of practice, competence and safety throughout our profession. This article, the first in a two-part series, will provide information to practitioners on the practice of sedation in dentistry, the circumstances where it may be appropriate instead of general anaesthesia and the risks involved with sedation. It will also discuss the specific training and qualifications required for dental practitioners to provide sedation. The second article in this series will outline the different techniques used to administer inhalation, oral and intravenous sedation in dentistry and will focus on specific methods that are practiced.
This review aims to assess the existing studies on propofol, a relatively new intravenous anesthetic, related to its abuse and addictive potential and to explain the neurobiological and neuropharmacological aspects of propofol addiction. Several neurobiological factors related to complex processes in the brain influence propofol abuse and addiction. In this review, we assessed the literature regarding propofol abuse and addiction, including both experimental and clinical studies. We selected articles from animal studies, case reports, clinical trials, meta-analyses, narrative reviews, and systemic reviews to extract all relevant crucial quantitative data with a measure of neurobiological and neuropharmacological aspects. Thus, the main goal of this study was to investigate the current literature and discuss the association between the central nervous system and propofol abuse and addiction in the context of addictive behavior. Current data suggest that propofol has a strong addictive potential and produces prominent addiction in both animals and humans. Thus, medical practitioners should exercise caution with propofol use, and we argue that this drug should be added to the list of controlled substances.
Background
Endoscopic retrograde cholangiopancreatography (ERCP) requires an ideal sedative that provides a predictable action duration and meets safety requirements. We compared the efficacies and safeties of remimazolam and propofol in patients who had undergone ERCP.
Methods
In this prospective, randomized, single‐blind, single‐center study, we compared the performances of remimazolam and propofol for inpatient ERCP. Study medications were administered under the supervision of an endoscopist. One hundred and ten patients scheduled to undergo ERCP were randomly assigned to receive remimazolam or propofol. The primary endpoint was a composite of successful completion of the procedure and no requirement for rescue medication. Secondary endpoints included sedation efficacy, recovery time, and adverse events.
Results
Of the 110 patients randomized, 108 underwent sedation, and ERCP (53 received remimazolam and 55 propofol). The primary endpoint was met for remimazolam and propofol in 100% of patients in both arms. Incidences and frequencies of emergent adverse events, including desaturation, requiring treatment were comparable in both arms. However, ERCP was started sooner in the propofol arm (mean, 63.18 ± 16.56 s) than in the remimazolam arm (75.23 ± 32.27 s; P ‐value = 0.02). Time to full alertness after ERCP was also significantly shorter in the propofol arm (304.18 ± 146.25 vs 448.34 ± 224.09 s; P ‐value <0.001).
Conclusion
Remimazolam is not inferior to propofol in achieving successful ERCP completion without rescue medication. Incidences of adverse events were comparable. Remimazolam is a safe and effective alternative to propofol for ERCP sedation, expanding options for clinicians and improving patient outcomes.
Aim
This retrospective observational study evaluates the safety and efficacy of intravenous sedation using midazolam only or combinations of two or three drugs including propofol and alfentanil for complex dental surgery such as implant placement or sinus augmentations.
Methods
The study analyses 60 patients aged 42-79 who required advanced sedation techniques for complex oral surgery procedures. Twenty patients had midazolam only(M), 10 patients a 2-drug combination of midazolam and propofol (MP) and a third group of 30 patients had the combination of midazolam, propofol and alfentanil (MAP). The last two regimens were carried out under the supervision of a dedicated consultant anaesthetist.
Results
Higher mean minimum heart rate (beats/min) was observed in the midazolam group compared to the group sedated with the three-drug regimen (p<0.05). The time between the last drug administration (LDA) and end of surgery (EOS) was significantly longer(p<0.005) in group M(≤45mins) compared to the other two sedation groups MP and MAP (≤15 minutes). The final titration of midazolam of 11.2 ± 4mg(5-20mg) was a significantly greater in group M than in either of group MP or MAP(p<0.05).
Conclusion
In patients requiring conscious sedation to undergo complex and lengthy oral surgery, a combination of agents (midazolam, propofol and alfentanil) can provide a predictable steady state of sedation up to the end of the surgery resulting in better operating conditions for the surgeon and improved patient co-operation. The shorter duration of action drugs propofol and alfentanil improved haemodynamic stability, sedation quality and reduce the final doses of each sedative agent.
The challenges of sedating a child for dental procedures are multifactorial: the patient’s age, health, temperament and emotional status, parental styles and concerns, clinician philosophy on patient management, extent and quality of clinician training and experiences with sedation, dental board regulation of sedation, issues of third-party coverage or parental reimbursement, knowledge of and adherence to sedation guidelines and legal requirements by clinicians, facility preparedness, and support staff experiences are but a few of many important considerations. To address these challenges, a pediatric dentist must be appropriately educated in both pharmacological and non-pharmacological techniques; well-trained in sedation procedures including patient rescue; intimately aware of local, state, and federal regulations; and compliant with the appropriate professional guidelines.
Background:
Propofol is widely used in routine clinical practice for the induction and maintenance of anaesthesia. Although propofol is regarded as a well tolerated anaesthetic, its effect on intact or damaged endothelial cells has not yet been elucidated.
Objective:
The aim of this study was to investigate the effects of different concentrations of propofol on cell damage, metabolic activity, barrier function and wound healing capacity of human endothelial cells.
Design:
An in vitro investigation.
Setting:
Research Laboratory of the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.
Materials:
In vitro cultures of primary human umbilical vein endothelial cells (HUVECs).
Interventions:
Intact HUVEC or wounded HUVEC monolayers were incubated with or without different concentrations of propofol (10, 30 and 100 μmol l).
Main outcome measures:
Cell damage, metabolic activity, monolayer permeability, wound healing capacity, protein phosphorylation.
Results:
Propofol did not alter the morphology, induce cell damage or influence metabolic activity of intact HUVEC cells. Permeability of a HUVEC monolayer was increased by propofol 100 μmol l (P < 0.05). Wound closure was inhibited by the addition of propofol 30 and 100 μmol l (P < 0.05 and P < 0.01). This effect was associated with increased phosphorylation of extracellular signal regulated kinases (Erk) 1/2 (30 and 100 μmol l; both P < 0.05) and decreased phosphorylation of Rho kinase (Rock) (100 μmol l; P < 0.05).
Conclusion:
Propofol does not damage intact endothelial cells, but increases permeability of an endothelial cell monolayer at high concentrations and inhibits wound closure in vitro. Further experimental and clinical in vivo research should be performed to clarify the influence of propofol on endothelial wound healing.
This study aimed to establish a new propofol target-controlled infusion (TCI) model in animals so as to study the general anesthetic mechanism at multi-levels in vivo. Twenty Japanese white rabbits were enrolled and propofol (10 mg/kg) was administrated intravenously. Artery blood samples were collected at various time points after injection, and plasma concentrations of propofol were measured. Pharmacokinetic modeling was performed using WinNonlin software. Propofol TCI within the acquired parameters integrated was conducted to achieve different anesthetic depths in rabbits, monitored by narcotrend. The pharmacodynamics was analyzed using a sigmoidal inhibitory maximal effect model for narcotrend index (NI) versus effect-site concentration. The results showed the pharmacokinetics of propofol in Japanese white rabbits was best described by a two-compartment model. The target plasma concentrations of propofol required at light anesthetic depth was 9.77±0.23 μg/mL, while 12.52±0.69 μg/mL at deep anesthetic depth. NI was 76.17±4.25 at light anesthetic depth, while 27.41±5.77 at deep anesthetic depth. The effect-site elimination rate constant (ke0) was 0.263/min, and the propofol dose required to achieve a 50% decrease in the NI value from baseline was 11.19 μg/mL (95% CI, 10.25–13.67). Our results established a new propofol TCI animal model and proved the model controlled the anesthetic depth accurately and stably in rabbits. The study provides a powerful method for exploring general anesthetic mechanisms at different anesthetic depths in vivo.
Intravenous sedation is frequently provided by anesthesiologists for phobic patients undergoing elective dental treatment in outpatient settings. Propofol is one of the most commonly used anesthetic agents that can result in apnea and respiratory depression, thereby posing potential difficulties with perioperative airway management. Dexmedetomidine has been utilized successfully in intravenous sedation for a wide variety of procedures and holds potential as an alternative to propofol in outpatient dental settings. However, as a single agent, it may not provide adequate depth of sedation and analgesia for oral rehabilitation. In this case report we demonstrate an effective alternative intravenous deep-sedation technique for an adult phobic patient undergoing oral rehabilitation utilizing 3 agents in combination: dexmedetomidine, ketamine, and midazolam. This combination of agents may be especially useful for those patients with a history of substance abuse, where administration of opioids may be undesirable or contraindicated.
ResearchGate has not been able to resolve any references for this publication.