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2013 ; 60
(4
): 162-77
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A comparison of fospropofol to midazolam for moderate sedation during outpatient
dental procedures
#MMPMID24423419
Yen P
; Prior S
; Riley C
; Johnston W
; Smiley M
; Thikkurissy S
Anesth Prog
2013[Win]; 60
(4
): 162-77
PMID24423419
show ga
Moderate intravenous (IV) sedation combined with local anesthesia is common for
outpatient oral surgery procedures. An ideal sedative agent must be safe and well
tolerated by patients and practitioners. This study evaluated fospropofol, a
relatively new sedative/hypnotic, in comparison to midazolam, a commonly used
benzodiazepine, for IV moderate sedation during oral and maxillofacial surgery.
Sixty patients were randomly assigned to either the fospropofol or the midazolam
group. Each participant received 1 ?g/kg of fentanyl prior to administration of
the selected sedative. Those in the fospropofol group received an initial dose of
6.5 mg/kg, with 1.6 mg/kg supplemental doses as needed. Those in the midazolam
group received initial doses of 0.05 mg/kg, followed by 0.02 mg/kg supplemental
doses. The quality of sedation in each patient was evaluated with regard to (a)
onset of sedation, maintenance, and recovery profile; (b) patient and surgeon
satisfaction; and (c) hemodynamic stability and adverse effects. The fospropofol
group demonstrated shorter physical recovery times than midazolam patients,
taking a mean of 11.6 minutes versus 18.4 minutes for physical recovery (P =
.007). Cognitive recovery comparison did not find any difference with a mean of
7.5 minutes versus 8.8 minutes between the 2 drug groups (P = .123). The
fospropofol group had a higher rate of local anesthetic injection recall (90.5 vs
44.4%, P = .004). Other parameters of recall were comparable. Two adverse effects
demonstrated significance, with more patients in the midazolam group experiencing
tachycardia (48.2 vs 9.4%, P = .001), and more patients in the fospropofol group
experiencing perineal discomfort (40.6 vs 0, P < .001). No significant difference
was found in any other measures of sedation safety, maintenance, or satisfaction.
Fospropofol, when administered intravenously by a dentist anesthesiologist at the
indicated dose in this study, appears to be a safe, well-tolerated alternative to
midazolam for intravenous moderate sedation during minor oral surgery procedures.
|*Hypnotics and Sedatives/adverse effects/pharmacology
[MESH]