Efficacy and cost analysis of intravenous conscious sedation for long oral surgery procedures.

Autor: Hassan H; Barts & The London School of Medicine & Dentistry, Queen Mary University, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, 4 Newark Street, Whitechapel, London E1 2AT, United Kingdom; Barts & The London School of Medicine & Dentistry, Queen Mary University, Institute of Dentistry, Royal London Dental Hospital, Turner Street, London E1 2AD, United Kingdom. Electronic address: h.hassan@qmul.ac.uk., Shado R; Barts & The London School of Medicine & Dentistry, Queen Mary University, Institute of Dentistry, Royal London Dental Hospital, Turner Street, London E1 2AD, United Kingdom., Novo Pereira I; University of Porto, Faculty of Dental Medicine, R. Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal., Mistry M; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Craig D; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Jazyk: angličtina
Zdroj: The British journal of oral & maxillofacial surgery [Br J Oral Maxillofac Surg] 2024 Jul; Vol. 62 (6), pp. 523-538. Date of Electronic Publication: 2024 Apr 18.
DOI: 10.1016/j.bjoms.2024.04.006
Abstrakt: The aim of this study was to determine what is considered a long oral surgery and conduct a cost-effective analysis of sedative agents used for intravenous sedation (IVS) and sedation protocols for such procedures. Pubmed and Google Scholar databases were used to identify human studies employing IVS for extractions and implant-related surgeries, between 2003 and July/2023. Sedation protocols and procedure lengths were documented. Sedative satisfaction, operator satisfaction, and sedation assessment were also recorded. Cost estimation was based on The British National Formulary (BNF). To assess bias, the Cochrane Risk of Bias tools were employed. This review identified 29 randomised control trials (RCT), six cohorts, 14 case-series, and one case-control study. The study defined long procedures with an average duration of 31.33 minutes for extractions and 79.37 minutes for implant-related surgeries. Sedative agents identified were midazolam, dexmedetomidine, propofol, and remimazolam. Cost analysis revealed midazolam as the most cost-effective option (<10 pence per procedure per patient) and propofol the most expensive option (approximately £46.39). Bias analysis indicated varying degrees of bias in the included studies. Due to diverse outcome reporting, a comparative network approach was employed and revealed benefits of using dexmedetomidine, propofol, and remimazolam over midazolam. Midazolam, dexmedetomidine, propofol, and remimazolam demonstrated safety and efficacy as sedative agents for conscious IVS in extended procedures like extractions or implant-related surgeries. While midazolam is the most cost-effective option, dexmedetomidine, propofol, and remimazolam offer subjective and clinical benefits. The relatively higher cost of propofol may impede its widespread use. Dexmedetomidine and remimazolam stand out as closely priced options, necessitating further clinical investigations for comparative efficacy assessment.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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