A six week intravenous sedation clinical experience in light of propofol ‘shortage’

Background: Office-based Oral and Maxillofacial Surgeons are commonly faced with lack of availability of commonly used IV anesthetic agents. During a recent shortage, clinical experience both with and without Propofol for sedation were compared.

Methods: Patients were grouped into: control treated with Propofol available (A) vs. treated when not available (B). Medicines were given only as needed to complete surgery, (for example, not all patients in group (A) were given Propofol; and not all patients in either group received Fentanyl or Versed or Ketamine. The only variable was the availability of Propofol for usage).

Results: Patients received 0.1 mg glycopyrrolate and 8 mg dexamethosone. Patients (79) in group (A) received average doses of 4.0 mg (0.05 mg/kg) Versed, 8.9 mcg (0.11 mcg/kg) Fentanyl and 32.8 mg (0.40 mg/kg) Ketamine. Thirty (38.0%) of the patients received an average of 34.5 mg Propofol. Average age of group (A) patients was 36.1 years, average weight was 81.8 kg. One patient received IV Ondansetron for nausea. One patient received IV Esmolol for hypertension. Two patients experienced anxiety/dysphoria. For one of these patients, the procedure was not completed. Patients (117) in group (B) received average doses of 4.8 mg (0.06 mg/kg) Versed, 40.6 mcg (0.51 mcg/kg) Fentanyl, and 40.8 mg(0.51 mg/kg) Ketamine. Average age of patients was 38.3 years, average weight was 79.9 kg. One patient received IV Ondansetron for nausea. One patient received IV Esmolol for sinus tachycardia. One patient experienced anxiety/dysphoria. Two patients were given IV Flumazenil and Naloxone for post operative somnolence. One of these patients experienced mild apnea. Patients in both groups met Aldrete criterea prior to discharge.

Conclusions: Although patients in group (B) for which Propofol was not available on average required larger doses of Versed, Fentanyl and Ketamine to produce a desired anesthetic result compared to (A), on average, an effective anesthetic result was obtained without the use of Propofol.

Key words: propofol shortage; intravenous sedation

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on A six week intravenous sedation clinical experience in light of propofol ‘shortage’
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