title: Analysis of propofol and low-dose ketamine admixtures for adult outpatient dentoalveolar surgery: a prospective, randomized, positive-controlled clinical trial.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the hemodynamic stability and efficacy of 3 different propofol-ketamine admixtures compared with a propofol-saline solution admixture for continuous-infusion intravenous general anesthesia in outpatient adult dentoalveolar surgery.
  
  
  METHODS
  This was a prospective, randomized, positive-controlled clinical trial between a propofol-saline solution admixture and 3 propofol-ketamine admixtures comprising 4 groups: group A (control), propofol and saline solution; group B, 10:1 propofol-ketamine ratio; group C, 5:1 propofol-ketamine ratio; and group D, 3:1 propofol-ketamine ratio. The bispectral index (BIS) was used to monitor all patients for time to induction (BIS <70) to recovery time (BIS >90). The outcome variables-noninvasive systolic, diastolic, and mean blood pressures; pulse; and BIS-were recorded at baseline and every 5 minutes during surgery. One-way analysis of variance and χ(2) analysis were conducted on the groups to determine statistical significance, set at P < .05. Post hoc pair-wise comparisons with Bonferroni adjustments were conducted on statistically significant groups.
  
  
  RESULTS
  A total of 64 adult patients (37 men and 27 women; mean age, 27.3 years) who had dentoalveolar surgery under intravenous general anesthesia in an outpatient oral and maxillofacial surgery clinic setting were enrolled in this study. There were statistically significant differences between mean values of groups only for mean systolic blood pressure and mean blood pressure in groups A and D (127 mm Hg vs 146 mm Hg and 96 mm Hg vs 109 mm Hg, respectively). There were statistically significant differences in percent change from baseline measurements only between groups A and D for systolic blood pressure (-6.9% vs +1.3%), diastolic blood pressure (-5.4% vs +0.7), and mean arterial pressure (-0.5% vs +2.6%). All mean percent changes from baseline were within 20% of baseline. There were statistically significant differences between groups for number of boluses but not time to surgery start, movement on injection, or length of surgery. Statistically significant differences in recovery times were found between all groups except between groups A and C and groups C and D. There were no incidences of postoperative nausea or vomiting in the immediate postoperative period.
  
  
  CONCLUSIONS
  Through maintenance of hemodynamic stability and faster recovery time, the group B admixture (10:1 propofol-ketamine ratio) provided the greatest benefit for continuous intravenous general anesthesia in adults undergoing dentoalveolar surgery in an outpatient clinic setting.
authors.affiliation: Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, PA 15212, USA. jecdna@aol.com
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Cillo
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000704:Analysis of Variance; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D016009:Chi-Square Distribution; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage*; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D007649:Ketamine; D015742:Propofol