Bispectral Index Guided Target Controlled Midazolam Sedation: a new advanced technique for dental procedures.

Objectives: To assess the efficacy and safety of Bispectral Index (BIS) guided Target Controlled Infusion (TCI) of midazolam for anxiolysis or minimal sedation during extensive periodontal or implant surgery in a single operator/sedationist model.

Methods: Retrospective analysis of thirty adult ASA 1 or ASA 2 patients undergoing periodontal surgery or dental implant surgery under local anaesthesia were included. The calculated effect site concentration (Ce) of midazolam applied by TCI, BIS, heart rate (HR), and peripheral oxygen saturation (SpO2) were monitored continuously. Non-invasive blood pressure (NIBP) and mean arterial pressure (MAP) were measured every 10 minutes. All peri-operative parameters were recorded every 10 minutes. All patients were interviewed 1 week after the procedure to explore their experience of sedation and the periodontal or implant surgery procedure.

Results: Extensive periodontal or implant surgery treatment in all 30 patients was completed in a mean time of 120 min (range 50-180 min). The calculated mean effect site concentration for midazolam was 50 ng/ml (range 24-80). The mean BIS was 85 (74-100) during induction and was maintained between 80 and 90 during the oral surgical procedure by adjusting TCI Ce. There were no clinically significant cardiopulmonary changes during midazolam infusion with regard to SpO2, NIBP, MAP and heart rate. Patients experienced profound anterograde amnesia and were very satisfied with the sedation and the surgical procedure.

Conclusions: BIS guided TCI sedation with midazolam facilitates predictable minimal sedation enabling long periodontal or implant surgery procedures by a single operator/sedationist within safe physiological limits.