Comparison of Methohexital and Propofol Use in Ambulatory Procedures in Oral and Maxillofacial Surgery
Purpose
Short-acting anesthetic agents, such as propofol and methohexital, are commonly used for ambulatory procedures in the practices of oral and maxillofacial surgeons (OMS). This study compares the safety and anesthetic outcomes of propofol and methohexital. In addition, the study compares the safety and outcomes of these agents when administered either by an OMS who simultaneously provides anesthesia and performs the procedure (anesthetist/surgeon), or by a non-OMS provider of anesthesia (anesthesiologist or certified registered nurse anesthetist; CRNA) whose sole obligation is to provide anesthesia.
Materials and Methods
This is a prospective study of anesthesia techniques used in an office-based ambulatory setting by OMS throughout the United States, in which either propofol or methohexital was used for sedation/anesthesia. The study variables included demographic information, anesthetic agent, adverse outcomes related to anesthesia, operative procedure, and provider of anesthesia. These variables were compared with the patient group that received a benzodiazepine/narcotics regimen for sedation (control group). Bivariate (contingency tables) and multivariate (logistic regression) analyses were conducted. P ≤ .05 was considered statistically significant.
Results
The study included 47,710 patients who met the inclusion criteria: 26,147 (54.8%) patients were in the propofol group, 15,859 (33.2%) were in the methohexital group, and 5,704 (12.0%) were in the benzodiazepine group. Among all study patients, 333 (0.7%) had an adverse event. The most common complication was nausea and vomiting without aspiration. Of the patients in the propofol group, methohexital group, or benzodiazepine group, 0.4%, 1.1%, and 0.8% had an adverse event, respectively. The higher number of complications among patients in the methohexital group compared with patients in the other 2 groups was statistically significant. Of 26,147 patients in the propofol group, 23,799 (91.0%) received anesthesia from an anesthetist/surgeon (OMS), and 2,368 (9.1%) from an anesthesiologist or nurse anesthetist (non-OMS). A total of 109 patients (0.4%) had an adverse event. The majority of patients who received anesthesia from a non-OMS were in the propofol group (2,368 of 2,404 patients; 98.5%). There was no statistically significant difference in the occurrence of adverse outcomes when comparing patients in the propofol group who received anesthesia from an OMS with those who received anesthesia from a non-OMS (P = .24, bivariate analysis; P = .33, multivariate analysis).
Conclusions
There is a statistically significant increase in adverse events related to methohexital compared with propofol or benzodiazepine/narcotics for anesthesia. Propofol appears to have the lowest risk for adverse events. There is no statistically significant difference in the number of adverse outcomes between the administration of propofol for ambulatory surgery by OMS as an anesthetist/surgeon and anesthesiologist/nurse anesthetist. It remains critical that our specialty maintains the highest standards, to provide safe anesthesia and to reduce adverse anesthetic events.
⁎Associate Professor of Clinical Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, University of California at San Francisco, San Francisco, CA
†Senior Research Associate, American Association of Oral and Maxillofacial Surgeons, Rosemont, IL
‡Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
§Principal Investigator and Former Chair, Outcomes Committee, American Association of Oral and Maxillofacial Surgeons, Rosemont, IL; and Senior Vice President/Medical Director, Medical Affairs, Salinas Valley Memorial Healthcare System, Salinas, CA
Address correspondence and reprint requests to Dr Perrott: Salinas Valley Memorial Healthcare System, 450 East Romie Lane, Salinas, CA 93901
This study was funded by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation.
ABSTRACT