Total intravenous sedation with target-controlled infusion in dentistry: clinical experience with the third-generation Eleveld pharmacokinetic/pharmacodynamic model.

BACKGROUND

Approximately 31% of adults experience dental anxiety, which represents a significant barrier to timely care and ultimately results in poor oral health outcomes. Moderate sedation is an effective method of managing anxiety while preserving patient responsiveness. Total intravenous anesthesia (TIVA) combined with target-controlled infusion (TCI) systems, which utilize pharmacokinetic models, enable precise control of drug delivery by maintaining stable effect-site concentrations. This study evaluated the safety and efficacy of moderate TCI-administered sedation using an Eleveld pharmacodynamic-pharmacokinetic model for propofol and remifentanil in dental practice.

METHODS

This prospective study included 114 patients who underwent dental procedures at two clinical sites. Moderate sedation was delivered via a TCI-guided Eleveld model, targeting the effect-site concentrations of propofol and remifentanil. The primary outcome was the incidence of adverse events as defined by the Tracking and Reporting Outcomes of Procedural Sedation criteria. The secondary outcomes included procedural duration, drug dosing, vital sign fluctuations, and patient-reported satisfaction.

RESULTS

After 7725 min of sedation, no adverse events were reported according to the TROOPS criteria. None of the patients experienced hypoxia (SpO2 <90%), bradycardia (HR < 40 bpm), or clinical over-sedation. Hypotension (MAP < 65 mmHg) occurred in 13 patients who were managed conservatively without intervention. The average recovery time was 10.1 ± 5.2 min. Patient satisfaction was high (99%), with 93.6% of patients reporting little to no recall of the procedure.

CONCLUSIONS

TCI-based moderate sedation using the Eleveld model for propofol and remifentanil is safe, effective, and well-tolerated in dental settings. The model offers predictable sedation depth, rapid recovery, and high levels of patient satisfaction, supporting its broader implementation in the management of dental anxiety.