Does patient-controlled sedation with propofol improve sedation quality and postoperative recovery compared to midazolam and fentanyl in day surgery patients undergoing third molar extraction?
Patient-controlled sedation with propofol provides better patient satisfaction and less postoperative cognitive impairment compared to standard midazolam and fentanyl for third molar extraction.
The quality of sedation and postoperative recovery have been assessed for intra-operative sedation provided by either patient-controlled sedation with propofol or a standard method using divided doses of midazolam and fentanyl, in 40 ASA 1 day surgery patients undergoing extraction of third molar teeth under local analgesia. Patient-controlled sedation with propofol produced sedation no deeper than full eyelid closure with prompt response to verbal command, but deeper levels were seen in three patients in the midazolam and fentanyl group. Patient satisfaction was higher in the patient-controlled sedation propofol group for both subjective intra-operative feelings (p less than 0.01) and willingness to have the procedure again in the same manner (p less than 0.05). Amnesia was more limited to intra-operative events (rather than extending into the postoperative period) in the patient-controlled sedation propofol group (p less than 0.05). Drug dose was correlated with duration of procedure and surgical difficulty in the patient-controlled sedation propofol group but not in the midazolam and fentanyl group. Postoperative testing included a new computerised test, the FAST index, which indicated a dose-dependent reduction in cognitive function in the midazolam and fentanyl group, which persisted until the time of discharge. Changes in cognitive function in the patient-controlled sedation propofol group in the same postoperative interval were significantly less and not related to propofol dose.
Osborne et al. (1991) studied this question.