Jul 2026· Community Based Medical Journal· 0 citations
TL;DR
Intravenous sedation is optimal for profound anxiolysis in complex cases, while nitrous oxide is ideal for routine procedures, prioritizing rapid recovery and fewer side effects.
Abstract
Selecting an optimal sedation technique is pivotal for balancing efficacy and safety in outpatient dental surgery. Nitrous oxide inhalation and intravenous sedation are widely used, yet comprehensive comparative data in similar clinical environments are needed to guide practice. The objective of this study was to prospectively compare the clinical efficacy, safety, and recovery profiles of nitrous oxide inhalation sedation versus intravenous midazolam sedation for outpatient dental surgical procedures. This prospective cohort study was conducted at Liberty Hospital Ltd. Paribagh, Shahbagh, Dhaka, Bangladesh, from January to December 2024. A purposive sample of 50 patients was allocated to receive either nitrous oxide/oxygen (n=25) or intravenous midazolam sedation (n=25). Efficacy was measured by procedure completion, operator satisfaction (10-point VAS), and patient-reported anxiety reduction. Safety outcomes included hemodynamic stability, adverse event incidence, and time to meet a modified Aldrete recovery score of ≥9. Data were analyzed using SPSS version 23.0. Both techniques achieved 100% procedure completion. Intravenous sedation provided superior operator satisfaction and greater anxiety reduction (p<0.001). However, nitrous oxide yielded a significantly faster recovery time (8.5 vs. 33.1 minutes, p<0.001) and lower rates of postoperative nausea (8.0% vs. 36.0%, p=0.021) and hypotension (4.0% vs. 32.0%, p=0.019). Hemodynamic changes were more pronounced with IV sedation. Intravenous sedation is optimal for profound anxiolysis in complex cases, while nitrous oxide is ideal for routine procedures, prioritizing rapid recovery and fewer side effects. The choice should be individualized based on patient factors and procedural demands.
CBMJ 2026 July: Vol. 15 No. 02 P:283-289
Objectives: The objective of the study was to assess the effectiveness and safety of dexmedetomidine versus midazolam for sedation during regional anesthesia surgery.
Methods: This prospective randomized comparative interventional study was conducted in the Department of Anesthesiology at a tertiary care hospital from January 2025 to January 2026. 100 adult patients undergoing elective surgeries under regional anesthesia were randomly divided into two groups: Group D (dexmedetomidine, n=50) and Group M (midazolam, n=50). Richmond agitation sedation scale (RASS) was used to evaluate sedation. Intraoperative monitoring of hemodynamic parameters, such as mean arterial pressure and heart rate, was performed. Recovery characteristics, patient satisfaction, requirement for rescue sedation and adverse effects were also assessed.
Results: The mean intraoperative RASS score was significantly lower in the Group D than in the Group M (−2.8±0.5 vs. −2.5±0.7; p=0.02). The time required to reach the target sedation level was significantly greater in Group D (9.4±2.6 min vs. 7.8±2.4 min; p=0.003). The scores of patient satisfaction with dexmedetomidine use were significantly greater than with midazolam use (8.5±1.0 vs. 7.9±1.2; p=0.01). Dexmedetomidine was associated with more adverse effects of bradycardia (p=0.08) and hypotension (p=0.46), whereas midazolam was associated with more adverse effects of excessive sedation (p=0.14) and restlessness (p=0.09).
Conclusion: Dexmedetomidine and midazolam were both found to be effective sedatives for patients undergoing regional anesthetic. Dexmedetomidine was found to be a more effective sedative, well tolerated, more patient-satisfying and more stable for intraoperative hemodynamic despite its comparatively slower onset of sedation than midazolam.
AVINASH KAREKAL, SRINIVAS KURAHATTI, Rashmi C· Asian Journal of Pharmaceuti...· 0 citations
Background: “
Dexmedetomidine and propofol are widely used intravenous sedatives for short procedures
requiring rapid onset, adequate sedation depth, hemodynamic stability, and early recovery. Their distinct
pharmacological profiles influence clinical outcomes.
Aim: To compare the efficacy, hemodynamic effects, recovery characteristics, adverse events, and satisfaction
outcomes of dexmedetomidine versus propofol for sedation in short procedures.
Methodology: This prospective, randomized comparative study included 90 ASA I–II patients (18–60 years)
undergoing elective short procedures (≤60 minutes) under monitored anesthesia care. Patients were allocated into
Group D (dexmedetomidine, n=45) and Group P (propofol, n=45). Hemodynamic parameters, Ramsay Sedation
Score, recovery time (Aldrete score ≥9), adverse events, and satisfaction scores were assessed and analyzed using
SPSS v27.
Results: Demographic characteristics were comparable between groups. Dexmedetomidine showed better
hemodynamic stability with higher minimum MAP (p=0.002) and SpO₂ (p=0.018), and fewer respiratory events
(p<0.05), but more bradycardia (p=0.046). Propofol provided faster onset (p=0.001) and shorter recovery time
(p=0.001). Sedation depth was comparable. Surgeon satisfaction was significantly higher with dexmedetomidine
(p=0.009).
Conclusion: Both agents are effective for short procedural sedation. Dexmedetomidine offers superior
cardiorespiratory stability, whereas propofol ensures faster recovery. Agent selection should be individualized.
Vikash Gaurav· International Journal of Pha...· 0 citations
BACKGROUND
Palliative sedation is used to relieve refractory suffering in terminally ill patients. Propofol, an intravenous anesthetic, may offer advantages due to its rapid onset and short half-life.
AIM
To evaluate the role of propofol in palliative sedation, focusing on symptom control, sedation depth, survival time, safety, and ethical implications.
DESIGN
Systematic review registered in PROSPERO (CRD42025643575; February 6, 2025).
DATA SOURCES
Scopus, MEDLINE, and Web of Science were searched for English-language studies (2005-2024) on propofol use in adult terminally ill patients. Studies comparing propofol with other sedatives or non-sedated controls were included; those involving anesthetic or intensive care settings were excluded. Risk of bias and certainty of evidence were assessed. Results were synthesized narratively.
RESULTS
Ten non-randomized studies were included (observational, cross-sectional, cohort, case series, and before-and-after designs), mostly of moderate quality, conducted in Europe (n = 7) involving 4072 patients (28,3% received palliative sedation), mainly with cancer. Symptom control was reported in 73%-100% of cases, target sedation depth was achieved in 52%-100%, although outcome definitions and measurement methods varied. Survival ranged from 19 h to 38 days. Propofol was used alone (n = 4) or with other sedatives (n = 6). Respiratory depression was the main safety concern. Ethical issues included absence of explicit consent and rare reports of life-shortening intent.
CONCLUSIONS
Propofol may be considered as a rescue option in selected refractory cases managed by experienced teams; however, given the low to very low certainty of available evidence, findings should be interpreted cautiously and supported by institutional protocols and further prospective research.
Luís Almeida-Jardim, P. Reis-Pina· Palliative Medicine· 0 citations
OBJECTIVES
Propofol is used sparingly in pediatrics owing to the risk of propofol-related infusion syndrome (PRIS). The objective of this study is to evaluate the safety of propofol in pediatrics and describe its effectiveness at facilitating extubation and decreasing concomitant sedation.
METHODS
This retrospective, descriptive study evaluated critically ill children who received continuous propofol infusions for at least 12 consecutive hours while admitted to pediatric, congenital cardiac, or neonatal intensive care units. The primary outcome was PRIS incidence. Secondary outcomes included change from baseline in laboratory parameters, discontinuation due to adverse effects, change in sedative requirements following sedation washout, and successful extubation.
RESULTS
From January 1, 2019, to November 1, 2023, a total of 100 children received 120 courses of propofol infusions. The median infusion rate was 106 mcg/kg/min (IQR, 68-149) and 27.5% of courses exceeded 48 hours in duration. No PRIS events were identified. Patients experienced a moderate, non-duration-dependent increase in triglycerides, with no impact on aspartate aminotransferase (AST)/alanine aminotransferase (ALT) concentrations; 11.7% of infusions were discontinued for adverse effects. No children self-extubated while on propofol when used for peri-extubation (N = 49). Opioid and benzodiazepine requirements were decreased by 17% and 26% from baseline, respectively, during a 24-hour period following sedation washout (N = 26).
CONCLUSIONS
Propofol was tolerated by most patients at doses commonly exceeding guideline-recommended maximum rate and duration. Propofol was safely used to facilitate extubation and decreased baseline sedative exposure when used for sedation washout in a complex critically ill pediatric population.
Benjamin Colwell, Ferras Bashqoy, Maria Spilios et al.· The Journal of Pediatric Pha...· 0 citations
Importance
Older adults undergoing major noncardiac surgery experience substantial postoperative morbidity and health care use. The comparative effectiveness of total intravenous anesthesia (TIVA) vs volatile-based inhalational anesthesia on recovery and safety remains uncertain.
Objectives
To determine whether TIVA improves days alive and at home at 30 days compared with inhalational anesthesia and to evaluate differences in patient-centered outcomes and recovery.
Design, Setting, and Participants
Pragmatic, multicenter, open-label randomized clinical trial conducted in 49 UK National Health Service hospitals from January 2022 to April 2024 (final follow-up, October 2024) among patients aged 50 years or older scheduled for elective major noncardiac surgery.
Interventions
Participants were randomized 1:1 to receive maintenance of general anesthesia with either TIVA (propofol infusion) (n = 1254) or volatile-based inhalational agents (n = 1254). All other perioperative care was at clinician discretion.
Main Outcomes and Measures
The primary outcome was days alive and at home at 30 days. Secondary outcomes included days alive and at home at 90 days; mortality at 30 days, 90 days, and 6 months; Quality of Recovery-15 score at day 3; patient satisfaction (Bauer Patient Satisfaction Questionnaire) at day 1; delirium (4 As Test [4AT]) at day 3; unintentional awareness under anesthesia; and major postoperative complications within 30 days.
Results
Among the 2508 randomized participants, the mean age was 67 (SD, 8.9) years, and 55% were male. Characteristics were balanced across randomized groups. Days alive and at home at 30 days were similar between groups (mean, 22.5 [SD, 6.8] days vs 22.4 [SD, 6.6] days for TIVA vs inhalational anesthesia, respectively; incidence rate ratio, 1.00; 95% CI, 0.99-1.02; adjusted P = .68). There were no differences in days alive and at home at 90 days; mortality at 30 days, 90 days, or 6 months; or Quality of Recovery-15 score at day 3. Lower rates of thirst, hoarseness, and nausea and vomiting were reported in the TIVA group. Levels of delirium were similar between groups, with the majority (87.6%) having no delirium at day 3. Major complications occurred in 12.4% of patients overall, with no significant between-group differences. Two cases of certain or probable unintentional awareness under anesthesia were reported, both in the TIVA group.
Conclusions and Relevance
Among older adults undergoing major noncardiac surgery, TIVA did not improve days alive and at home at 30 days compared with inhalational anesthesia.
Trial Registration
ISRCTN.org Identifier: ISRCTN62903453.
S. Jhanji, Katie Booth, Louise Hiller et al.· Journal of the American Medi...· 1 citation
Background:Functional Endoscopic Sinus Surgery (FESS) requires a clear and bloodless surgical field for optimal visualization and prevention of intraoperative complications. Controlled hypotension is commonly employed during FESS to reduce blood loss and improve surgical conditions. Dexmedetomidine and Propofol are widely used agents for controlled hypotensive anesthesia. The present study was conducted to compare the efficacy of dexmedetomidine and propofol infusion in achieving controlled hypotension during FESS.Methodology:This prospective randomized comparative study was conducted in the Department of Anaesthesiology at Sree Mookambika Institute of Medical Sciences from June 2025 to March 2026. A total of 100 patients aged between 18 and 40 years belonging to ASA Grade I and II undergoing elective FESS were included in the study. Patients were randomly allocated into two groups of 50 each. Group D received dexmedetomidine infusion at 0.4–0.8 μg/kg/hr, while Group P received propofol infusion at 75–100 μg/kg/min following induction of general anesthesia. Intraoperative pulse rate, mean arterial pressure, blood loss, quality of surgical field, sedation score, and complications were assessed and compared between the two groupsResults:Baseline demographic and hemodynamic parameters were comparable between the groups. Intraoperative pulse rate and mean arterial pressure were significantly lower in the dexmedetomidine group at various time intervals compared with the propofol group (p<0.05). Quality of surgical field and mean blood loss were comparable in both groups. Postoperative Ramsay sedation scores at 30 minutes were significantly higher in the propofol group (p=0.023). No major complications were observed in either group.Conclusion:Both dexmedetomidine and propofol were effective and safe agents for controlled hypotension during FESS. Dexmedetomidine provided superior intraoperative hemodynamic stability with comparable surgical field quality and blood loss, making it a useful alternative to propofol for hypotensive anesthesia in endoscopic sinus surgery.
Dr. Balakrishnan, Dr. Subhasan JV· Asian Journal of Medical Res...· 0 citations