TCI Anesthesia in the Dental Clinic

Background: Between 5% and 85 of Americans avoid dentists out of fear, and need sedation . But there are also patients with special needs.

Objective: We review our experience with this special population.

Methods: TheOral Medicine department treats patients with special needs that undergo treatments with moderate sedation. 25% of these patients fail this kind of sedation, and therefore are referred for deep sedation to the Sedation Unit.

TCI technique was used in order to achieve smooth induction, reliable and titrable maintenance and rapid emergence, that are important in this population.

After obtaining informed consent , an IV was inserted , midazolam was given as a "premedication". As soon as the patient became "cooperative", the TCI pump was connected (Therasys) with a Propofol infusion according to the Marsh model.

Results: 100 consecutive patients were anesthetized in a 18 m period.

All the patients were monitored by standard monitoring + BIS (Covidien) that allowed maintaining the patients in a state of deep sedation(40-60)

3 patients did not complete the treatment because of excess of secretions, coughing and subsequent desaturation.

20 patients needed a supplement of low-dose ketamine because of painful treatment.

24 patients received a nasal airway because OSA.

The rest of the patients completed the treatment without any complication, were stable and woke-up within 5 min, according to the TCI pump. All were discharged home after 30 minutes.

Conclusion: TCI anesthesia/sedation with BIS monitor proved to be a safe and simple technique for a setting far from the traditional OR environment.