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Evaluation of patient-controlled sedation (PCS) during surgical removal of impacted lower third molars.

Year 2016, Volume: 3 Issue: 1, 7 - 15, 15.01.2016

Abstract

Objectives: The current study was conducted to evaluate the safety of patient-controlled sedation (PCS) and the efficiency of elastomeric infusion device during surgical removal of impacted lower third molars and its impact on patients regarding level of sedation, patients’ satisfaction and psycho-motor recovery.

Materials and methods:Twenty patients were equally divided into two groups chosen randomly. In both groups, 0.03 mg/kg Midazolam and 0.5 mg/kg Propofol were administered IV as a bolus dose. Group 1 was then given 0.3 mg/kg/hr Ketamine and 1.2 mg/kg/hr Propofol as a maintenance dose delivered through the PCS pump. Group 2 was then given 0.3 µg/kg/hr Fentanyl and 1.2 mg/kg/hr Propofol as a maintenance dose delivered through the PCS pump. For all patients’ surgical procedure were done under local anesthesia. Before going to the operating theatre all patients were instructed about the PCS pump and familiarized with it. Patients in both groups were evaluated for hemodynamic stability, patient's &surgeon's satisfaction, psychomotor recovery and adverse effects.

 

Results: The results of this study showed no statistical difference between the two groups. The use of different drug combinations in both groups showed hemodynamic stability, patients’& surgeon's satisfaction and rapid psychomotor recovery. None of the patients in both groups suffered from any adverse reactions such as: nausea, vomiting, hallucinations, involuntary movements, or over-sedation.

Conclusion: PCS can be considered as a safe option in minor oral surgeries providing the majority of patients with high satisfaction and relaxation, also providing the surgeons with good operating conditions and the cooperation of the majority of the patients. Fentanyl-Propofol and Ketamine-Propofol combinations were both safe with respect to hemodynamic changes with rapid recovery of psychomotor functions in all patients.

References

  • Garip H, Abali O, Goker K, Gokturk U, Garip Y. Anxiety and extraction of third molars in Turkish patients. Br J Oral Maxillofac Surg 2004; 42:551-4.
  • Kucukyavuz Z, Cambazoglu M. Effects of low-dose midazolam with propofol in patient-controlled sedation (PCS) for apicectomy . Br J Oral Maxillofac Surg 2004; 42:215–20.
  • Anaesthesia, Grattidge R.: Patient-controlled sedation using propofol in day surgery. and 683-85., 47:,1992.
  • Earl P: Patients’ anxieties with third molar surgery. Br J Oral Maxillofac Surg 32:293, 1994.
  • Yusa H, Onizawa K, Hori M, et al: Anxiety measurements in university students undergoing third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:23, 2004.
  • O'Neil R and VerrillP J. Intravenousdiazepam in minor oral surgery. Br .J Oral Surg and 12-14., 7, 1969.
  • EJ, Smilack ZH and Florucci RD. Sedation with intravenous diazepam. J Oral Surg 1972; 332., 30:.
  • Rudkin GE, Osborne GA, Curtis NJ: Intra-operative patient controlled sedation. Anaesthesia 1991; 46:90-92.
  • Koyama T, McHaffie JG, Laurienti PJ, et al. The subjective experience of pain:where expectations become reality. Proc Natl Acad Sci U S A 2005; 102:12950–12955.
  • Esen E, U¨ stu¨n Y, Balcıog˘lu O, Alparslan ZN. Evaluation of patient-controlled remifentanil application in third molar surgery. J Oral Maxillofac Surg 2005; 63:457–63.
  • Sa Rego MM, Watcha MF, White PF. The changing role of monitored anesthesia care in anesthesiology. Anesth Analg 1997; 36., 85:1020-.
  • Smith I, Monk TG, White PF, Ding Y. Propofol infusion during regional anaesthesia: sedative, amnestic, and anxiolytic properties. Anesth Analg 1994; 313–9, 79:.
  • Smith I, White PF, Nathanson M, Gouldson R. Propofol: an update on its clinical use. Anesthesiology 1994; 43., 81:1005-.
  • Smith C, McEwan AI, Jhaveri R, et al. The interaction of fentanyl on the Cp50 of propofol for loss of consciousness and skin incision. Anesthesiology 1994; 8., 81:820 -.
  • Vukyk J, Lim T, Engbers FH, Burm AG, Vletter AA, Bovill JG. The pharmacodynamic interaction of propofol and alfentanil during lower abdominal surgery in women. Anesthesiology 1995; 22., 83:8 -.
  • Avramov MN, White PF - Use of alfentanil and propofol for outpatient monitored anesthesia care: determining the optimal dosing regimen. Anesth Analg. 1997; 85(3):566-572.
  • White PF, Way WL, Trevor AJ. Ketamine—its pharmacology and therapeutic uses. Anesthesiology 1982; 36., 56:119-.
  • Suzuki M, Tsueda K, Lansing PS, et al. Small-dose ketamine enhances morphine-induced analgesia after outpatient surgery. Anesth Analg 1999; 103., 89:98 -.
  • Sadove MS, Shulman M, Hatano S, Fevold N. Analgesic effects of ketamine administered in subdissociative doses. Anesth Analg 1971; 7., 50:452 -.
  • Frey K, Sukhani R, Pawlowski J, Pappas AL, Mikat-Stevens M, Slogoff S. Propofol versus propofol-ketamine sedation for retrobulbar nerve block:comparison of sedation quality, intraocular pressure changes, and recovery profiles. Anesth Analg 1999; 21, 89:317-.
  • Badrinath S, Avramov MN, Shadrick M,Witt TR, Ivankovich AD. The use of a ketamine-propofol combination during monitored anesthesia care. Anesth Analg 2000; 62., 90:858-.
  • Herrick IA, Craen RA, Gelb AW, Miller LA, Kubu CS, Girvin JP, Parrent AG, Eliasziw M, Kirkby J.,Propofol sedation during awake craniotomy for seizures: patient-controlled administration versus neurolept analgesia.Anesth Analg. 1997 Jun; 84(6):1285-91.
  • Wong-baker faces pain rating scale.
  • Godwin SA, Caro DA, Wolf SJ, et al. American College of Emergency Physicians. ACEP clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005; 45:177-196.
  • Centers for Medicare & Medicaid Services (CMS). Revised appendix A, interpretive guidelines for hospitals— state operations manual, anesthesia services. Effective December 2, 2011.
  • American Society of Anesthesiologists. Continuum of depth of sedation: definition of general anesthesia and levels of sedation/ analgesia. October 21, 2009.
  • Rodrigo C, Chow KC. Patient-controlled sedation: a comparison of sedation prior to and until the end of minor oral surgery. Aust Dent J 1996; 41:159—63.
  • Thorpe SJ, Balakrishan VR, Cook LB. The safety of patient-controlled sedation. Anaesthesia 1997; 52:1144—50.
  • Irwin MG, Thompson N, Kenny GN. Patient-maintained propofol sedation. Assessment of a target-controlled infusion system. Anaesthesia 1997; 525–30, 52:.
  • Park WY, Watkins PA: Patient-controlled sedation during epidural anesthesia. Anesth Analg 1991; 72:304-307.
  • Osborne GA, Rudkin GE, Curtis NJ, Vickers D, Craker AJ. Intra-operative patientcontrolled sedation. Anaesthesia 1991; 553-556., 46:.
  • Ganapathy S, Herrick IA, Gelb AW, Kirkby J: Propofol patient-controlled sedation during hip or knee arthroplasty in elderly patients. Can J Anaesth 1997; 44:385-389.
  • Rodrigo MRC, Tong CKA: A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery. Anaesthesia 1994; 49:241-244.
  • Zuhal Küçükyavuz, Mine Cambazo glu:Effects of low-dose midazolam with propofol in patient-controlled sedation (PCS) for apicectomy. British Journal of Oral and Maxillofacial Surgery (2004) 42, 215—220.

Aktham Adel shoukry1*, Mohamed Magdy bakr2, Sameh Mekhemer3, Salah Yassin3

Year 2016, Volume: 3 Issue: 1, 7 - 15, 15.01.2016

Abstract

References

  • Garip H, Abali O, Goker K, Gokturk U, Garip Y. Anxiety and extraction of third molars in Turkish patients. Br J Oral Maxillofac Surg 2004; 42:551-4.
  • Kucukyavuz Z, Cambazoglu M. Effects of low-dose midazolam with propofol in patient-controlled sedation (PCS) for apicectomy . Br J Oral Maxillofac Surg 2004; 42:215–20.
  • Anaesthesia, Grattidge R.: Patient-controlled sedation using propofol in day surgery. and 683-85., 47:,1992.
  • Earl P: Patients’ anxieties with third molar surgery. Br J Oral Maxillofac Surg 32:293, 1994.
  • Yusa H, Onizawa K, Hori M, et al: Anxiety measurements in university students undergoing third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:23, 2004.
  • O'Neil R and VerrillP J. Intravenousdiazepam in minor oral surgery. Br .J Oral Surg and 12-14., 7, 1969.
  • EJ, Smilack ZH and Florucci RD. Sedation with intravenous diazepam. J Oral Surg 1972; 332., 30:.
  • Rudkin GE, Osborne GA, Curtis NJ: Intra-operative patient controlled sedation. Anaesthesia 1991; 46:90-92.
  • Koyama T, McHaffie JG, Laurienti PJ, et al. The subjective experience of pain:where expectations become reality. Proc Natl Acad Sci U S A 2005; 102:12950–12955.
  • Esen E, U¨ stu¨n Y, Balcıog˘lu O, Alparslan ZN. Evaluation of patient-controlled remifentanil application in third molar surgery. J Oral Maxillofac Surg 2005; 63:457–63.
  • Sa Rego MM, Watcha MF, White PF. The changing role of monitored anesthesia care in anesthesiology. Anesth Analg 1997; 36., 85:1020-.
  • Smith I, Monk TG, White PF, Ding Y. Propofol infusion during regional anaesthesia: sedative, amnestic, and anxiolytic properties. Anesth Analg 1994; 313–9, 79:.
  • Smith I, White PF, Nathanson M, Gouldson R. Propofol: an update on its clinical use. Anesthesiology 1994; 43., 81:1005-.
  • Smith C, McEwan AI, Jhaveri R, et al. The interaction of fentanyl on the Cp50 of propofol for loss of consciousness and skin incision. Anesthesiology 1994; 8., 81:820 -.
  • Vukyk J, Lim T, Engbers FH, Burm AG, Vletter AA, Bovill JG. The pharmacodynamic interaction of propofol and alfentanil during lower abdominal surgery in women. Anesthesiology 1995; 22., 83:8 -.
  • Avramov MN, White PF - Use of alfentanil and propofol for outpatient monitored anesthesia care: determining the optimal dosing regimen. Anesth Analg. 1997; 85(3):566-572.
  • White PF, Way WL, Trevor AJ. Ketamine—its pharmacology and therapeutic uses. Anesthesiology 1982; 36., 56:119-.
  • Suzuki M, Tsueda K, Lansing PS, et al. Small-dose ketamine enhances morphine-induced analgesia after outpatient surgery. Anesth Analg 1999; 103., 89:98 -.
  • Sadove MS, Shulman M, Hatano S, Fevold N. Analgesic effects of ketamine administered in subdissociative doses. Anesth Analg 1971; 7., 50:452 -.
  • Frey K, Sukhani R, Pawlowski J, Pappas AL, Mikat-Stevens M, Slogoff S. Propofol versus propofol-ketamine sedation for retrobulbar nerve block:comparison of sedation quality, intraocular pressure changes, and recovery profiles. Anesth Analg 1999; 21, 89:317-.
  • Badrinath S, Avramov MN, Shadrick M,Witt TR, Ivankovich AD. The use of a ketamine-propofol combination during monitored anesthesia care. Anesth Analg 2000; 62., 90:858-.
  • Herrick IA, Craen RA, Gelb AW, Miller LA, Kubu CS, Girvin JP, Parrent AG, Eliasziw M, Kirkby J.,Propofol sedation during awake craniotomy for seizures: patient-controlled administration versus neurolept analgesia.Anesth Analg. 1997 Jun; 84(6):1285-91.
  • Wong-baker faces pain rating scale.
  • Godwin SA, Caro DA, Wolf SJ, et al. American College of Emergency Physicians. ACEP clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005; 45:177-196.
  • Centers for Medicare & Medicaid Services (CMS). Revised appendix A, interpretive guidelines for hospitals— state operations manual, anesthesia services. Effective December 2, 2011.
  • American Society of Anesthesiologists. Continuum of depth of sedation: definition of general anesthesia and levels of sedation/ analgesia. October 21, 2009.
  • Rodrigo C, Chow KC. Patient-controlled sedation: a comparison of sedation prior to and until the end of minor oral surgery. Aust Dent J 1996; 41:159—63.
  • Thorpe SJ, Balakrishan VR, Cook LB. The safety of patient-controlled sedation. Anaesthesia 1997; 52:1144—50.
  • Irwin MG, Thompson N, Kenny GN. Patient-maintained propofol sedation. Assessment of a target-controlled infusion system. Anaesthesia 1997; 525–30, 52:.
  • Park WY, Watkins PA: Patient-controlled sedation during epidural anesthesia. Anesth Analg 1991; 72:304-307.
  • Osborne GA, Rudkin GE, Curtis NJ, Vickers D, Craker AJ. Intra-operative patientcontrolled sedation. Anaesthesia 1991; 553-556., 46:.
  • Ganapathy S, Herrick IA, Gelb AW, Kirkby J: Propofol patient-controlled sedation during hip or knee arthroplasty in elderly patients. Can J Anaesth 1997; 44:385-389.
  • Rodrigo MRC, Tong CKA: A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery. Anaesthesia 1994; 49:241-244.
  • Zuhal Küçükyavuz, Mine Cambazo glu:Effects of low-dose midazolam with propofol in patient-controlled sedation (PCS) for apicectomy. British Journal of Oral and Maxillofacial Surgery (2004) 42, 215—220.
There are 34 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Aktham Shoukry

Mohamed Bakr This is me

Sameh Mekhemer This is me

Salah Yassin This is me

Publication Date January 15, 2016
Published in Issue Year 2016 Volume: 3 Issue: 1

Cite

APA Shoukry, A., Bakr, M., Mekhemer, S., Yassin, S. (2016). Evaluation of patient-controlled sedation (PCS) during surgical removal of impacted lower third molars. Medical Science and Discovery, 3(1), 7-15. https://doi.org/10.17546/msd.20288
AMA Shoukry A, Bakr M, Mekhemer S, Yassin S. Evaluation of patient-controlled sedation (PCS) during surgical removal of impacted lower third molars. Med Sci Discov. January 2016;3(1):7-15. doi:10.17546/msd.20288
Chicago Shoukry, Aktham, Mohamed Bakr, Sameh Mekhemer, and Salah Yassin. “Evaluation of Patient-Controlled Sedation (PCS) During Surgical Removal of Impacted Lower Third Molars”. Medical Science and Discovery 3, no. 1 (January 2016): 7-15. https://doi.org/10.17546/msd.20288.
EndNote Shoukry A, Bakr M, Mekhemer S, Yassin S (January 1, 2016) Evaluation of patient-controlled sedation (PCS) during surgical removal of impacted lower third molars. Medical Science and Discovery 3 1 7–15.
IEEE A. Shoukry, M. Bakr, S. Mekhemer, and S. Yassin, “Evaluation of patient-controlled sedation (PCS) during surgical removal of impacted lower third molars”., Med Sci Discov, vol. 3, no. 1, pp. 7–15, 2016, doi: 10.17546/msd.20288.
ISNAD Shoukry, Aktham et al. “Evaluation of Patient-Controlled Sedation (PCS) During Surgical Removal of Impacted Lower Third Molars”. Medical Science and Discovery 3/1 (January 2016), 7-15. https://doi.org/10.17546/msd.20288.
JAMA Shoukry A, Bakr M, Mekhemer S, Yassin S. Evaluation of patient-controlled sedation (PCS) during surgical removal of impacted lower third molars. Med Sci Discov. 2016;3:7–15.
MLA Shoukry, Aktham et al. “Evaluation of Patient-Controlled Sedation (PCS) During Surgical Removal of Impacted Lower Third Molars”. Medical Science and Discovery, vol. 3, no. 1, 2016, pp. 7-15, doi:10.17546/msd.20288.
Vancouver Shoukry A, Bakr M, Mekhemer S, Yassin S. Evaluation of patient-controlled sedation (PCS) during surgical removal of impacted lower third molars. Med Sci Discov. 2016;3(1):7-15.