J Dent Anesth Pain Med.  2016 Sep;16(3):165-173. 10.17245/jdapm.2016.16.3.165.

Smart syringe pumps for drug infusion during dental intravenous sedation

• Seo KS
• Lee K

• KMID: 2354651
• DOI: http://doi.org/10.17245/jdapm.2016.16.3.165

Abstract

Dentists often sedate patients in order to reduce their dental phobia and stress during dental treatment. Sedatives are administered through various routes such as oral, inhalation, and intravenous routes. Intravenous administration has the advantage of rapid onset of action, predictable duration of action, and easy titration. Typically, midazolam, propofol or dexmedetomidine are used as intravenous sedatives. Administration of these sedatives via infusion by using a syringe pump is more effective and successful than infusing them as a bolus. However, during intravenous infusion of sedatives or opioids using a syringe pump, fatal accidents may occur due to the clinician's carelessness. To prevent such risks, smart syringe pumps have been introduced clinically. They allow clinicians to perform effective sedation by using a computer to control the dose of the drug being infused. To ensure patient safety, various alarm features along with a drug library, which provides drug information and prevents excessive infusion by limiting the dose, have been added to smart pumps. In addition, programmed infusion systems and target-controlled infusion systems have also been developed to enable effective administration of sedatives. Patient-controlled infusion, which allows a patient to control his/her level of sedation through self-infusion, has also been developed. Safer and more successful sedation may be achieved by fully utilizing these new features of the smart pump.

Keyword

Drug libraries; Infusion pump; Patient controlled; Sedation

MeSH Terms

Administration, Intravenous
Analgesics, Opioid
Dental Anxiety
Dentists
Dexmedetomidine
Humans
Hypnotics and Sedatives
Infusion Pumps
Infusions, Intravenous
Inhalation
Midazolam
Patient Safety
Propofol
Syringes*
Analgesics, Opioid
Dexmedetomidine
Hypnotics and Sedatives
Midazolam
Propofol

Figure

• 

  Fig. 1 The user interface of the drug library editor program. The standard drug concentration and the soft and hard limits of the drug dose are entered here. A drug library of each drug made in this program is saved into the syringe pump and limits the drug dose during infusion.

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  Fig. 2 This is the LCD screen of the syringe pump control panel. The bolus dose (5 µg/kg), which is the loading dose, is infused for 10 minutes, and the infusion rate is decreased to 1.0 µg/kg/min. The VTBI (volume to be infused) is limited to 50 ml.

• 

  Fig. 3 An illustration of drug infusion by using target-controlled infusion (TCI). Once the target concentration (Ct) has been set, the infusion rate is automatically adjusted to reach the effect site concentration (Ce). By showing the change in concentration with time on a graph, one can also observe the pattern of changes in the plasma concentration (Cp).

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