Deep Sedation for Pediatric Dental Patients using Adjunct Remifentanil Boluses - Abstract
Remifentanil has been widely described for a number of sedation procedures, but concerns of apnea and the relative costs may limit its use. In this study, we substituted remifentanil boluses for fentanyl boluses in an established intravenous sedation protocol for oral surgery procedures. Remifentanil sedation was evaluated through the Richmond Agitation Sedation Score (RASS). The dosing regimen produced a median RASS score corresponding to deep sedation for the duration of the procedure. Compared with the historical controls, the RASS was not statistically different. Time to discharge from the recovery room and incidence of airway obstruction was significantly greater in the historical group as compared to the remifentanil group. The new remifentanil protocol was found to be effective as evidenced by RASS. The use of remifentanil bolus however
proved more labor intensive, but appeared to have an acceptable safety profile compared with established standards for the areas of major concern, including apnea, chest wall rigidity, and hypotension. Finally, cost discrepancies between remifentanil and fentanyl could be mitigated through dividing the remifentanil vial between multiple patients. Overall, we concluded that remifentanil bolus, while not superior in the modality, could prove an acceptable substitute during periods of shortage.