Comparison of propofol-remifentanil versus propofol-ketamine deep sedation for third molar surgery.
This study aimed to compare continuous intravenous infusion combinations of propofol-remifentanil and propofol-ketamine for deep sedation for surgical extraction of all 4 third molars. In a prospective, randomized, double-blinded controlled study, participants received 1 of 2 sedative combinations for deep sedation for the surgery. Both groups initially received midazolam 0.03 mg/kg for baseline sedation. The control group then received a combination of propofol-remifentanil in a ratio of 10 mg propofol to 5 μg of remifentanil per milliliter, and the experimental group received a combination of propofol-ketamine in a ratio of 10 mg of propofol to 2.5 mg of ketamine per milliliter; both were given at an initial propofol infusion rate of 100 μg/kg/min. Each group received an induction loading bolus of 500 μg/kg of the assigned propofol combination along with the appropriate continuous infusion combination . Measured outcomes included emergence and recovery times, various sedation parameters, hemodynamic and respiratory stability, patient and surgeon satisfaction, postoperative course, and associated drug costs. Thirty-seven participants were enrolled in the study. Both groups demonstrated similar sedation parameters and hemodynamic and respiratory stability; however, the ketamine group had prolonged emergence (13.6 ± 6.6 versus 7.1 ± 3.7 minutes, P = .0009) and recovery (42.9 ± 18.7 versus 24.7 ± 7.6 minutes, P = .0004) times. The prolonged recovery profile of continuously infused propofol-ketamine may limit its effectiveness as an alternative to propofol-remifentanil for deep sedation for third molar extraction and perhaps other short oral surgical procedures, especially in the ambulatory dental setting.
Department of Oral Surgery and Hospital Dentistry, Indiana University School of Dentistry, Indianapolis, IN, USA. kjkramer@iupui.edu
Kyle J
KJ
Kramer
Steven
S
Ganzberg
Simon
S
Prior
Robert G
RG
Rashid
D000293:Adolescent; D000328:Adult; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000191:economics / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000191:economics; D001794:Blood Pressure / Q000187:drug effects; D054810:Deep Sedation / Q000191:economics / Q000379:methods*; D055191:Delayed Emergence from Anesthesia / Q000139:chemically induced; D004311:Double-Blind Method; D016527:Drug Costs; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000191:economics; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D008297:Male; D008964:Molar, Third / Q000601:surgery*; D010100:Oxygen / Q000097:blood; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage* / Q000191:economics; D011184:Postoperative Period; D015742:Propofol / Q000008:administration & dosage* / Q000191:economics; D011446:Prospective Studies; D000077208:Remifentanil; D056152:Respiratory Rate / Q000187:drug effects; D014081:Tooth Extraction / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D019162:Anesthetics, Combined; D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D010880:Piperidines; D007649:Ketamine; D000077208:Remifentanil; D010100:Oxygen; D015742:Propofol