For most dental procedures, performed in an outpatient setting, the desired level of sedation is light to moderate.
Sedation in these procedures aims to ensure the safety and well-being of the patient, minimizing discomfort and allowing the surgical procedure to be carried out in complete safety, with sedation with TCI (Target Controlled Infusion) being an added value.
Sedation is achieved with the administration of hypnotic and sedative drugs, generally intravenously, and various forms of administration can be used.
The objective of all forms of administration is to achieve and maintain the therapeutic effect of the medication during the procedure, avoiding adverse effects. Intravenous medications are generally administered according to “standard” doses. Typically, for intravenous anesthetic drugs, the only incorporated patient covariate is weight. Patient characteristics such as age, sex, or renal function are often not included due to a complex mathematical relationship of these covariates to dose.
Historically, there are 2 methods of administering drugs intravenously during anesthesia/sedation:
However, anesthetic drugs accumulate in tissues during administration, particularly if they are administered continuously and/or prolonged. Therefore, the amount of drug to be infused over time cannot be constant and will have to be adjusted, which is difficult with these methods.
This difficulty can be overcome with calculations carried out by a “computer / microprocessor” incorporated into an infusion pump. The mathematical complexity of incorporating patient characteristics (e.g. weight, height, age, sex and additional biomarkers) are trivial calculations for a computer. Using well-known pharmacokinetic principles, computers can calculate the amount of drug that has accumulated in tissues during infusion and can adjust the infusion rate to maintain a stable concentration in the plasma or tissue of interest, typically the brain. This is the basis of a third type of anesthetic drug administration, target-controlled infusion (“TCI”).
With TCI systems, the Anesthesiologist enters a desired target concentration. The “microprocessor” calculates the amount of medication needed to be administered as an initial bolus and the flow rate to be maintained subsequently, to reach the desired concentration at the brain level. If it is necessary to reduce or increase the degree of sedation, the Anesthesiologist simply defines the desired drug concentration and the “computer” makes the calculations automatically.
TCI thus allows very stable brain concentrations of the drug to be obtained and allows simple and predictable control of the depth of sedation. Furthermore, it allows the sedation level to be adjusted quickly, reliably and precisely. The use of fast metabolizing drugs in the form of TCI guarantees safety, efficiency and versatility.
Carrying out intravenous sedation, using continuous perfusion equipment capable of performing sedation with TCI, allows high levels of safety and quality to be guaranteed, providing personalized sedation suitable for carrying out the planned procedure.