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Analysis of Dose Escalation of Propofol Associated With Frequent Sedation
Yoshihiro Nakaike DDS,
 Hikaru Sato DDS,
 Rina Sato DDS,
 Hikaru Moriyama DDS,
 Shota Abe DDS,
 Kenji Yoshida DDS,
 Hiroyoshi Kawaai DDS, PhD, and
 Shinya Yamazaki DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 66: Issue 2
Online Publication Date: Jan 01, 2019
DOI: 10.2344/anpr-66-02-08
Page Range: 97 – 102

the dose of propofol was not recognized during the early sessions of intravenous sedation. The dose escalation of propofol could be due to either pharmacokinetic effects, such as alterations in drug metabolism through repeated exposure or extrahepatic metabolism, or pharmacodynamic effects, such as receptor adaptation. Moreover, there are case reports of multiple propofol sedations for children undergoing frequent procedures. 4 , 5 These studies also showed an increase in propofol dosage, and it was speculated that the mechanisms of tolerance might be

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Figure 1.; (a) Cold-Pressor and (b) Heat Pain Tolerance and Severity in Opioid-Using and Ppioid-Naïve Patients. Decreased pain tolerance and increased perceived pain severity (mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain across cold-pressor and heat pain assays.
Peggy Compton,
 Steven Wang,
 Camron Fakhar,
 Stacey Secreto,
 Olivia Halabicky Arnold,
 Brian Ford, and
 Elliot V. Hersh
Figure 1.
Figure 1.

(a) Cold-Pressor and (b) Heat Pain Tolerance and Severity in Opioid-Using and Ppioid-Naïve Patients.

Decreased pain tolerance and increased perceived pain severity (mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain across cold-pressor and heat pain assays.

Figure 1. ; Changes in mean infusion rate of propofol. Graphs show the correlation between the frequency of intravenous sedation and mean dosage of propofol. In the upper graph, the dosage tended to increase with increasing frequency, particularly after the 30th and the 60th episode of intravenous sedation. In the lower graph, as the administration interval decreased, a tendency of a considerable increase in propofol dosage was observed.
Yoshihiro Nakaike,
 Hikaru Sato,
 Rina Sato,
 Hikaru Moriyama,
 Shota Abe,
 Kenji Yoshida,
 Hiroyoshi Kawaai, and
 Shinya Yamazaki
<bold>Figure 1.</bold>
Figure 1.

Changes in mean infusion rate of propofol. Graphs show the correlation between the frequency of intravenous sedation and mean dosage of propofol. In the upper graph, the dosage tended to increase with increasing frequency, particularly after the 30th and the 60th episode of intravenous sedation. In the lower graph, as the administration interval decreased, a tendency of a considerable increase in propofol dosage was observed.

Figure 2. ; Regression and correlation analysis between the mean infusion rate of propofol and frequency (total number of cases, only propofol, propofol, and other sedative drugs). A significant positive correlation was observed between the frequency of intravenous sedation and the dosage of propofol. A tendency for a slower increase in propofol dosage was seen when combined with other drugs such as midazolam ± butorphanol, as the slope of the regression line is decreased.
Yoshihiro Nakaike,
 Hikaru Sato,
 Rina Sato,
 Hikaru Moriyama,
 Shota Abe,
 Kenji Yoshida,
 Hiroyoshi Kawaai, and
 Shinya Yamazaki
<bold>Figure 2.</bold>
Figure 2.

Regression and correlation analysis between the mean infusion rate of propofol and frequency (total number of cases, only propofol, propofol, and other sedative drugs). A significant positive correlation was observed between the frequency of intravenous sedation and the dosage of propofol. A tendency for a slower increase in propofol dosage was seen when combined with other drugs such as midazolam ± butorphanol, as the slope of the regression line is decreased.

Figure 3. ; Regression and correlation analysis between the mean infusion rate of propofol and frequency (total number of cases, target-controlled infusion, and step-down method). A significant positive correlation was observed between the frequency of intravenous sedation and the dosage of propofol in each situation. The step-down method exhibited the higher increase in rate of propofol infusion at 0.18 mg/kg/h per administration versus TCI at 0.07 mg/kg/h per administration.
Yoshihiro Nakaike,
 Hikaru Sato,
 Rina Sato,
 Hikaru Moriyama,
 Shota Abe,
 Kenji Yoshida,
 Hiroyoshi Kawaai, and
 Shinya Yamazaki
<bold>Figure 3.</bold>
Figure 3.

Regression and correlation analysis between the mean infusion rate of propofol and frequency (total number of cases, target-controlled infusion, and step-down method). A significant positive correlation was observed between the frequency of intravenous sedation and the dosage of propofol in each situation. The step-down method exhibited the higher increase in rate of propofol infusion at 0.18 mg/kg/h per administration versus TCI at 0.07 mg/kg/h per administration.

Delirium During Intravenous Sedation With Midazolam Alone and With Propofol in Dental Treatment
Y. Mohri-Ikuzawa DDS, PhD,
 H. Inada DDS,
 N. Takahashi DDS, PhD,
 H. Kohase DDS, PhD,
 S. Jinno DDS, PhD, and
 M. Umino DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 53: Issue 3
Online Publication Date: Jan 01, 2006
DOI: 10.2344/0003-3006(2006)53[95:DDISWM]2.0.CO;2
Page Range: 95 – 97

's smaller tolerance to midazolam and propofol. REFERENCES 1 Cheng , C. , C. , Roemer-Becuwe , and J. Pereira . When midazolam fails. J Pain Symptom Manage 2002 . 23 : 256 – 265 . 2 Doyle , W. L. and L. Perrin . Emergence delirium in a child given oral midazolam for conscious sedation. Ann Emerg Med 1994 . 24 : 1173 – 1175 . 3

Preoperative and Postoperative Hyperalgesia in Dental Patients on Chronic Opioid Therapy: A Pilot Study
Peggy Compton RN, PhD,
 Steven Wang DMD, MD, MPH,
 Camron Fakhar MD, DDS,
 Stacey Secreto CCRC,
 Olivia Halabicky Arnold RN, PhD,
 Brian Ford MD, DMD, and
 Elliot V. Hersh DMD, MS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 1
Online Publication Date: Mar 28, 2023
DOI: 10.2344/anpr-69-03-03
Page Range: 9 – 16

equivalents (MMEs) for at least 3 months, and opioid-naïve patients reported no opioid use within the last 3 months and were without chronic pain. Potential participants were excluded from participation if they had an active substance use disorder (except nicotine) or a neurological or psychiatric illness known to affect pain responses as confirmed by the electronic health record. To ensure tolerance to the experimental pain assay and the postoperative analgesics, patients with untreated hypertension, a history of gastrointestinal ulcers, NSAID-induced asthma or allergy, or

Managing Pain—the Canadian Healthcare Professional's Reference, 2nd Edition
Dr Earle R. Young BSc, DDS, BScD, MSc, FADSA
Article Category: Book Review
Volume/Issue: Volume 52: Issue 1
Online Publication Date: Mar 01, 2005
DOI: 10.2344/0003-3006(2005)52[42:MPCHPR]2.0.CO;2
Page Range: 42 – 43

-glucuronide receptor, that appears separate from the more commonly known μ, κ, and δ receptors. In addition, opioid analgesic tolerance has been described as involving secondary messenger systems in the dorsal horn of the spinal cord such as cholecystokinin and protein kinase C, which can change the state of the opioid receptor. Several chapters cover the addiction that may happen when these opioid drugs are used in pain management. Once again, repeated emphasis is placed on both preemptive analgesia and the rapid treatment of acute pain before the condition becomes

Literature Review for Office-Based Anesthesia
All summaries and comments provided by Mark A Saxen DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 67: Issue 1
Online Publication Date: Jan 01, 2020
DOI: 10.2344/0003-3006-67.1.60
Page Range: 60 – 62

comparable levels of minimal and moderate sedation, both drugs produced similar degrees of pharyngeal collapsibility and reductions in ventilatory drive, suggesting that dexmedetomidine does not offer inherent protection against upper airway obstruction or ventilatory depression. Comment: (see * below) Weerink M, Barends C, Muskiet E, Reyntjens K, Knotnerus F, Oostra M, van Bocxlaer J, Struys M, Colin P. Pharmacodynamic interaction of remifentanil and dexmedetomidine on depth of sedation and tolerance of laryngoscopy. Anesthesiology . 2019

Anaesthesia for the High Risk Patient
Dr Earle R. Young BSc, DDS, BScD, MSc, FADSA
Article Category: Book Review
Volume/Issue: Volume 52: Issue 1
Online Publication Date: Mar 01, 2005
DOI: 10.2344/0003-3006(2005)52[41:AFTHRP]2.0.CO;2
Page Range: 41 – 42

each one concludes with an impressive section entitled “Further Reading” and then “References.” The book relies heavily on the terms reserve, functional capacity, exercise tolerance , and optimization , as well as on implications for the type and site of surgery and its duration. The format is clearly designed to provide easy access to information presented in a concise manner. The actual styles of the chapters vary. Some relate more to basic physiology, medical principles, and pharmacology, whereas others are more practical, discussing the principles of