Anesthesia Progress –The demand for outpatient dental procedures is increasing and, along with it, the requirement for sedatives that meet the needs of both patient and the dentist. For many outpatient oral surgical procedures, an intravenous sedative and local anesthetic are used, but there are many drug combinations and techniques. A new drug being evaluated, fospropofol, shows promise as a safe and effective intravenous sedative.

The current issue of the journal Anesthesia Progress reports on a comparison of two drugs, midazolam, a widely used sedation medication, and fospropofol for intravenous moderate sedation. Midazolam relieves anxiety, and provides sedation and amnesia; however, it can be slow to take effect, does not always adequately relieve discomfort from the procedure, and may require a longer physical recovery time. Fospropofol has also been shown to relieve anxiety, to take effect more quickly and to allow patients to recover physically in less time.

Sixty patients scheduled for oral surgery participated in a single-center clinical trial and were randomly selected to receive either midazolam or fospropofol. Both of these intravenous sedation drugs were paired with fentanyl and local anesthesia. Each drug was evaluated for the onset and maintenance of sedation, safety, cardiovascular stability, time to patient recovery, adverse effects, and patient and surgeon satisfaction.

There were no significant differences in sedation maintenance, safety, or patient and surgeon satisfaction. The fospropofol group had a shorter mean physical recovery time than the midazolam group, although there was no significant difference in cognitive recovery times. Among significant adverse effects, more patients receiving midazolam experienced an increased heart rate, whereas more patients receiving fospropofol reported perineal discomfort. The patients receiving fospropofol also had a higher rate of local anesthetic injection recall. Although fospropofol appears to be a safe alternative to midazolam when administered by anesthesia-trained dentists, such side effects may preclude its completely replacing midazolam.

Full text of “A Comparison of Fospropofol to Midazolam for Moderate Sedation During Outpatient Dental Procedures,” Anesthesia Progress, Vol. 60, No. 4, 2013, is available at https://anesthesiaprogress.org/doi/full/10.2344/0003-3006-60.4.162.