(21) Conscious Moderate Intravenous Sedation Under a Novel Controlled Dosing Protocol: A Case Series

Introduction: Formal sedation training is a part of many medical and dental sub-specialty training and should not be neglected due to its importance from a patient safety as well as comfort perspective. Midazolam and Fentanyl are most widely used drug of choice for conscious moderate intravenous sedation (CMIVS). Previous studies have shown the difficulty to determine the titration for correct dosage of the drugs by any form of calculation based on patient’s age or body weight. To overcome this, we have developed a controlled dosing protocol (CDP) that would sedate the patient with minimal complications. In this study, we examined the acceptability and effectiveness of this new CDP for patients who are candidate for CMIVS.

Methods: After IRB approval we reviewed 15 sedation charts. Chart review included their pre-screening and general medical history, STOPBANG risk factors for OSA and Mallampati and Tonsil scores. Based on patient’s age and weight, maximum dose of local anesthesia, along with CDP calculation was done. Midazolam and Fentanyl was given at the first cycle at four time intervals, with order of midazolam - fentanyl - midazolam - fentanyl followed by 10-30 minutes subsequent dosing. Minimum of oxygen was given 2L/min throughout procedure. NIBP, SpO2, EtCO2, ECG were monitored during sedation, every 5 minutes. Patient was monitored for at least 20 minutes before discharge.

Results: All patients were successful with sedation without significant complications. Average age/weight was 56.9 years/74.9kg. Average procedure time was 106.5 minutes. Richmond Sscoring (RASS) did not go below moderate sedation level (-3), and was evenly maintained throughout procedure. Average and maximum dose of fentanyl was 104.2±39.2 mcg and 200mcg, and for midazolam, 4.6±1.8 mg and 8mg. Average lidocaine dose was 151.4mg. Occasional chin lift was needed for 13.3% of cases and O2 saturation range 93-95% was about 26.7% of cases. No over-sedation and vomiting were noted, nor was a jaw thrust needed.

Conclusions: The use of CDP has tremendous potential to improve our routine sedation clinical practice in both academic and private settings.

Lead Author’s Contributions to the Research Project: The Lead Author was responsible for the data collection, performing the data analysis and the composition of the abstract.