Efficacy and cost analysis of intravenous conscious sedation for long oral surgery procedures

Aim To determine what is considered a long oral surgery and conduct a cost-effective analysis of sedative agents used for intravenous sedation(IVS) and sedation protocols for such procedures. Method Pubmed and Google Scholar databases were used to identify human studies employing IVS for extractions and implant-related surgeries, between 2003 and July/2023. Sedation protocol and procedures length were documented. Sedative satisfaction, operator satisfaction, and sedation assessment were also recorded. Cost estimation was based on The British National Formulary(BNF). For assessing bias, the Cochrane Risk of Bias tools were employed. Results This review identified 29 randomised control trials(RCT), 6 cohorts, 14 case-series, and 1 case-control study. The study defined long procedures with an average duration of 31.33 minutes for extractions and 79.37 minutes for implant-related surgeries. Sedative agents identified were midazolam, dexmedetomidine, propofol, and remimazolam. Cost analysis revealed midazolam as the most cost-effective option (<10 pence per procedure per patient) and propofol the most expensive option (approximately £46.39). Bias analysis indicated varying degrees of bias in the included studies. Due to diverse outcome reporting, a comparative network approach was employed and revealed benefits of using dexmedetomidine, propofol and remimazolam over midazolam. Conclusion Midazolam, dexmedetomidine, propofol, and remimazolam demonstrated both safety and efficacy as sedative agents for conscious IVS in extended procedures like extractions or implant-related surgeries. While midazolam is the most cost-effective option, dexmedetomidine, propofol, and remimazolam offer subjective and clinical benefits. The relatively higher cost of propofol may impede its widespread use. Dexmedetomidine and remimazolam stand out as closely priced options, necessitating further clinical investigations for comparative efficacy assessment.