Comparative Analysis Of Conscious Sedation Techniques: A Systematic Review

Objectives: Propofol and nitrous oxide use in conscious sedation is a reliable method, resulting in decreased recovery time for patients and decreased operating time for clinicians. As sedation dentistry increase in demand, the need for a gold standard becomes necessary. Several drug combinations are used to achieve optimal sedation with varied rates of success. The aim of this study was to analyze outcomes of conscious intravenous sedation for dental procedures.
Methods: Electronic search of the COCHRANE and MEDLINE databases and hand searching up to April 2018 was conducted. Two reviewers independently and in duplicates identified eligible studies using specific data extraction and assessment forms. The PRISMA and MECIR guidelines were the basis for the current systematic review analyses.
Results: The search identified 567 potential publications. After review of abstracts and titles, 42 articles qualified for full-text review where seven studies satisfied the inclusion criteria allowing two analyses. The first analysis compared single versus multiple drugs showing weighted mean procedure time of 29.85+5.18min versus 50.50+20.69min and recovery time of 30.35+4.22min versus 32.50+13.50min. The second analysis showed weighted mean of procedure time 36.8±6.2min; recovery time 12.1±0.9min; total dosage 255.8±13.0mg for propofol with nitrous versus procedure time 47.8±5.9min; recovery time 22.7±8.9min, total dosage 160.7±15.8mg for propofol as a single/in combination with other drugs without nitrous.
Conclusions: Analyses showed longer procedure time for multiple drugs compared to single drug use; that could be due to the complexity of the procedure and need for deeper sedation. Subsequently, the recovery time was slightly longer for multiple drugs. Further, the weighted mean showed that the use of propofol alone resulted in longer recovery time and procedure length but a lower total dosage than when combined to propofol and nitrous oxide. Definitive conclusions regarding conscious sedation cannot be made and data should be interpreted with caution due to limited number of studies.