J Dent Anesth Pain Med.  2016 Sep;16(3):217-222. 10.17245/jdapm.2016.16.3.217.

Use of ADMSâ„¢ during sedation for dental treatment of an intellectually disabled patient: a case report

• Chi SI
• Kim HJ
• Seo KS
• Yang M
• Chang J

• KMID: 2354659
• DOI: http://doi.org/10.17245/jdapm.2016.16.3.217

Abstract

Dental treatment is often performed under general anesthesia or sedation when an intellectually disabled patient has a heightened fear of treatment or has difficulty cooperating. When it is impossible to control the patient due to the severity of intellectual disability, conscious sedation is not a viable option, and only deep sedation should be performed. Deep sedation is usually achieved by propofol infusion using the target controlled infusion (TCI) system, with deep sedation being achieved at a slightly lower concentration of propofol in disabled patients. In such cases, anesthesia depth monitoring using EEG, as with a Bispectral Index (BIS) monitor, can enable dental treatment under appropriate sedation depth. In the present case, we performed deep sedation for dental treatment on a 27-year-old female patient with mental retardation and severe dental phobia. During sedation, we used BIS and a newly developed Anesthetic Depth Monitor for Sedation (ADMSâ„¢), in addition to electrocardiography, pulse oximetry, blood pressure monitoring, and capnometry for patient safety. Oxygen was administered via nasal prong to prevent hypoxemia during sedation. The BIS and ADMSâ„¢ values were maintained at approximately 70, and dental treatment was successfully performed in approximately 30 min..

Keyword

ADMS; Anesthesia depth monitoring; Disabilities; Propofol; Sedation

MeSH Terms

Adult
Anesthesia
Anesthesia, General
Anoxia
Blood Pressure Monitors
Conscious Sedation
Deep Sedation
Dental Anxiety
Electrocardiography
Electroencephalography
Female
Humans
Intellectual Disability
Oximetry
Oxygen
Patient Safety
Propofol
Oxygen
Propofol

Figure

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  Fig. 1 Dental treatment under intravenous propofol sedation with BIS and ADMS sensors attached.

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  Fig. 2 Use of BIS and ADMS monitor.

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  Fig. 3 Changes in BIS and ADMS qCon values under propofol 3 µg/ml target controlled infusion.

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  Fig. 4 The qCON algorithm is based on the combination of the energy of four frequency ratios, which generates an index, which is then offset by the value of the EEG suppression rate, called BSR (Burst Suppression Ratio). The four frequency ratios are: B1 = ln E(4-8 Hz)/E(1-44 Hz), B2 = ln E(8-13 Hz)/E(1-44 Hz), B3 = ln E(11-22 Hz)/E(1-44 Hz), and B4 = ln E(33-44 Hz)/E(1-44 Hz).

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