Dental Sedation For Patients With Intellectual Disability

Objectives: Intravenous sedation using propofol is effective for dental patients with intellectual disability. However, since excessive propofol infusion may induce complications and delays recovery, the establishment of a standard method for propofol infusion is expected. This study is to clarify the benefits of propofol sedation using target-controlled infusion (TCI) combined with bispectral index (BIS) monitoring in patients with intellectual disability in a randomized clinical trial. Methods: This study was approved by the Ethics Committee of our institute. Participants of this study were 40 dental patients with intellectual disability. After obtaining informed consent from their legal guardians, participants were randomly divided into two groups: a manually controlled infusion group (MCI group) and the TCI-BIS group. In both groups, we used both midazolam and propofol. In the MCI group, we adjusted propofol to maintain sedation level at Ramsay score 5. In the TCI-BIS group, we adjusted the setting of the target concentration of the TCI pump to a BIS value between 50 and 70. In a preliminary study, we confirmed that the BIS value between 50 and 70 was equivalent to Ramsay score 5 in patients with intellectual disability. We compared the average infusion rate of propofol and the recovery time of eyelash reflex and eye opening between the two groups. Results: TCI-BIS significantly reduced the average infusion rate of propofol and shortened the recovery times to eyelash reflex and eye opening. Values in blood pressure, pulse rate and oxygen saturation were within clinically normal limits in both groups during and after sedation. None of the patients in either group had any significant complication throughout the procedure. Conclusions: Our findings suggest that propofol sedation using TCI and BIS is available to prevent excessive infusion of propofol leading to safer management and earlier recovery from intravenous sedation for dental patients with intellectual disability.