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Target-Controlled Infusion with Propofol and Remifentanil for Moderate Procedural Sedation in Medicine and Dentistry: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: November 16, 2020
Project Number: RC1315-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of intravenous propofol and remifentanil administered by independent target-controlled infusion pumps for patients undergoing moderate procedural sedation in medicine and dentistry?
  2. What is the cost-effectiveness of intravenous propofol and remifentanil administered by independent target-controlled infusion pumps for patients undergoing moderate procedural sedation in medicine and dentistry?
  3. What are the evidence-based guidelines regarding the use of intravenous propofol and remifentanil administered by independent target-controlled infusion pumps for patients undergoing moderate procedural sedation in medicine and dentistry?

Key Message

One non-randomized single-arm study was identified regarding the safety of intravenous propofol and remifentanil administered by independent target-controlled infusions pumps for patients undergoing moderate sedation for bronchoscopy. No relevant economic evaluations or evidence-based guidelines were identified regarding the cost-effectiveness or use of intravenous propofol and remifentanil administered by independent target-controlled infusion pumps for patients undergoing moderate procedural sedation in medicine and dentistry. Overall, the body of evidence was limited in quantity and quality.Favourable visual analogue scale scores for dyspnea, pain, cough, and anxiety were reported by patients who received intravenous propofol and remifentanil administered by independent target-controlled infusion pumps operated by specialist sedation nurses. Additionally, favourable visual analogue scale scores for dyspnea, pain, cough, and discomfort were reported by bronchoscopists. Desaturation and hypotension occurred in four and two of 32 procedures, respectively, with no occurrence of serious adverse events.

The included study had several methodological limitations. The small sample size (N = 13) and lack of comparison to other sedation strategies should be considered when interpreting the findings of this report. Without comparator groups, it is unclear if these favourable safety outcomes are related to target-controlled infusions of propofol and remifentanil. Furthermore, statistical tests were not performed to evaluate changes from baseline for relevant outcomes.