Intravenous ketamine, propofol and propofol-ketamine combination used for pediatric dental sedation: A randomized clinical study

Dilek Gunay Canpolat, Mustafa Denizhan Yildirim, Recep Aksu, Nukhet Kutuk, Alper Alkan, Kenan Cantekin, Dilek Gunay Canpolat, Mustafa Denizhan Yildirim, Recep Aksu, Nukhet Kutuk, Alper Alkan, Kenan Cantekin

Abstract

Background and objective: Dental treatments cannot bealways performed under local anesthesia inpediatric non-cooperative patients. For this purpose, differentanesthetic techniques have been applied to increase patient comport to dental treatments.

Methods: Sixty children classified as ASA I-II, between aged 3 to 9, who were scheduled to undergo tooth extraction, were enrolled for this randomized study. Group K received 1 mg/kg ketamine, Group P received 1 mg/kg propofol, and Group KP received 0.5 mg/kg propofol plus 0.5 mg/kg ketamine intravenously for anesthesia induction.

Results: Recovery time was significantly lower in Group P than Group KP. No significant differences were found between groups regarding HR, before and after the induction, at tenth minute. Fifth minute's HR was higher in Group K than Group KP. Mean arterial pressure (MAP) values were similar at baseline, before and after the induction, and at tenth minute, whereas significantly lower values were found in Group P and Group KP than in Group K at fifth minute.

Conclusions: Although ketamine, propofol and ketamine-propofol combination are effective for sedation in tooth extraction in pediatric patients, propofol may be an excellent alternative, with the shortest recovery, no nausea and vomiting, and reasonable surgical satisfaction.

Keywords: Ketamine; Propofol; Sedation; Tooth extraction.

Figures

Fig.1
Fig.1
Heart Rate of the groups (beat/min) aHigher in Group K than Group KP, bSignificant increase compared with baseline.
Fig.2
Fig.2
Mean arterial pressure of the groups (mmHg). aSignificant decrease compared with Group K, cSignificant decrease compared with Group KP, bSignificant increase compared with basaline

References

    1. Giovannitti JA., Jr Dental anesthesia and pediatric dentistry. Anesth Prog. 1995;42:95–99.
    1. Cantekin K, Yildirim MD, Cantekin I. Assessing change in quality of life and dental anxiety in young children following dental rehabilitation under general anesthesia. Pediatr Dent. 2014;36(1):12E–17E.
    1. Cantekin K, Yildirim MD, Delikan E, Cetin S. Postoperative discomfort of dental rehabilitation under general anesthesia. Pak J Med Sci. 2014;30(4):784–788. doi:10.12669/pjms.304.4807.
    1. Roelofse JA, Shipton EA, de la Harpe CJ, Blignaut RJ. Intranasal sufentanil/midazolam versus ketamine/midazolam for analgesia/sedation in the pediatric population prior to undergoing multiple dental extractions under general anesthesia:a prospective, double-blind, randomized comparison. Anesth Prog. 2004;51:1114–21.
    1. Alletag MJ, Auerbach MA, Baum CR. Ketamine, propofol, and ketofol use for pediatric sedation. Pediatr Emerg Care. 2012;28:1391–1395. doi:10.1097/PEC.0b013e318276fde2.
    1. Rai K, Hegde AM, Goel K. Sedation in uncooperative children undergoing dental procedures:a comparative evaluation of midazolam, propofol and ketamine. J Clin Pediatr Dent. 2007;32:1–4. doi:10.17796/jcpd.32.1.v74872j8n74qu81k.
    1. Frankl SN, Shiere F, Fogels HR. Should the parent remain with the child in the dental operatory? J Dent Child. 1962;29:150–163.
    1. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;22:656–659.
    1. Steward DJ. A simplified scoring system for the post-operative recovery room. Can Anaesth Soc J. 1975;22:111–113.
    1. Canpolat DG, Esmaoglu A, Tosun Z, Akin A, Boyaci A, Coruh A. Ketamine-propofol vs ketamine-dexmedetomidine combinations in pediatric patients undergoing burn dressing changes. J Burn Care Res. 2012;33:718–722. doi:10.1097/BCR.0b013e3182504316.
    1. Almenrader N, Passariello M, Coccetti B, Haiberger R, Pietropaoli P. Premedication in children:a comparison of oral midazolam and oral clonidine. Paediatr Anaesth. 2007;17:1143–1149. doi:10.1111/j.1460-9592.2007.02332.x.
    1. Seto M, Sakamoto Y, Takahashi H, Kita R, Kikuta T. Does planned intravenous sedation affect preoperative anxiety in patients? Int J Oral Maxillofac Surg. 2013;42:497–501. doi:10.1016/j.ijom.2012.09.014.
    1. Major E, Winder M, Brook AH, Berman DS. An evaluation of nitrous oxide in the dental treatment of anxious children. A physiological and clinical study. Br Dent J. 1981;15:186–191. doi:10.1038/sj.bdj.4804653.
    1. Hosey MT, Makin A, Jones RM, Gilchrist F, Carruthers M. Propofol intravenous conscious sedation for anxious children in a specialist paediatric dentistry unit. Int J Paediatr Dent. 2004;14:2–8. doi:10.1111/j.1365-263X.2004.00521.x.
    1. Wood M. The use of intravenous midazolam and ketamine in paediatric dental sedation. SAAD Dig. 2013;29:18–30.
    1. Guit JB, Koning HM, Coster ML, Niemeijer RP, Mackie DP. Ketamine as analgesic for total intravenous anaesthesia with propofol. Anaesthesia. 1991;46:24–27. doi:10.1111/j.1365-2044.1991.tb09308.x.
    1. Lebovic S, Reich DL, Steinberg LG, Vela FP, Silvay G. Comparison of propofol versus ketamine for anesthesia in pediatric patients undergoing cardiac catheterization. Anesth Analg. 1992;74:490–4.
    1. Akin A, Esmaoglu A, Guler G, Demircioglu R, Narin N, Boyaci A. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatr Cardiol. 2005;26:553–557. doi:10.1007/s00246-004-0707-4.
    1. Yalcin S, Aydoğan H, Selek S, Kucuk A, Yuce HH, Karababa F, et al. Ketofol in electroconvulsive therapy anesthesia:two stones for one bird. J Anesth. 2012;26:562–567. doi:10.1007/s00540-012-1378-6.
    1. Tosun Z, Esmaoglu A, Coruh A. Propofol-ketamine vs propofol-fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes. Pediatr Anesth. 2008;18:43–47. doi:10.1111/j.1460-9592.2007.02380.x.
    1. Kramer KJ, Ganzberg S, Prior S, Rashid RG. Comparison of propofol-remifentanil versus propofol-ketamine deep sedation for third molar surgery. Anesth Prog. 2012;59:107–117. doi:10.2344/12-00001.1.
    1. Erden IA, Pamuk AG, Akinci SB, Koseoglu A, Aypar U. Comparison of propofol-fentanyl with propofol-fentanyl-ketamine combination in pediatric patients undergoing interventional radiology procedures. Pediatr Anesth. 2009;19:500–506. doi:10.1111/j.1460-9592.2009.02971.x.
    1. Akin A, Esmaoglu A, Tosun Z, Gulcu N, Aydogan H, Boyaci A. Comparison of propofol with propofol-ketamine combination in pediatric patients undergoing auditory brainstem response testing. Int J Pediatr Otorhinolaryngol. 2005;69:1541–1545. doi:10.1016/j.ijporl.2005.04.011.
    1. Andolfatto G, Abu-Laban RB, Zed PJ, Staniforth SM, Stackhouse S, Moadebi S, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia:a randomized double-blind trial. Ann Emerg Med. 2012;59:504–512. doi:10.1016/j.annemergmed.2012.01.017.
    1. Shah A, Mosdossy G, McLeod S, Lehnhardt K, Peddle M, Rieder M. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2012;57:425–433. doi:10.1016/j.annemergmed.2010.08.032.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren