Comparison of Propofol-Remifentanil Versus Propofol-Ketamine Deep Sedation for Third Molar Surgery

Abstract

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.

Assessment of Perianesthesic Data in Subjects Undergoing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

“…30 In our study, shorter recovery times might be due to intermittent and titrated bolus injection of sedative agents. Recovery time was the fastest in the propofol-only group, whereas it was the longest in the propofol-midazolam-ketamine group.…”

Comparison of propofol-ketamine versuspropofol-remifentanil in children anaesthetized for gastroscopy

“…Also, the additional dose of propofol was lower than in our study, and the comfort of work was assessed by the gastroenterologists as very good. In our study, nearly half of the subjects in Group R required repeated attempts to insert an endoscope, which was clearly assessed by gastroenterologists as worse examination conditions compared to Group K. In the study of healthy young adults anaesthetized for dental procedures as well as in the population of young children anaes thetized for changing dressings, there was no difference in the assessment of the conditions of the procedure between propofol with ketamine or propofol with remifentanil [6,7]. Perhaps it is because of the specifics of gastroscopy, during which endoscope insertion is one of the most difficult moments during the examination.…”

“…A group of children with anaesthesia using propofol alone required additional doses of the drug, and was characterized by apnoea and injection pain [9]. Both Kramer and Seol reported nearly double the time to the return of consciousness after using propofol and ketamine compared to propofol and remifentanil [6,7]. These studies were conducted in two extremely different age groups (12-36 months of age and adults aged [18][19][20][21][22][23][24].…”

Comparison of Ketamine-Midazolam-Propofol Combination and Fentanyl-Midazolam-Propofol Combination for Sedation in Colonoscopy

“…Despite the presence of analgesic effect of ketamine, it is not one of the frequently used agents in endoscopic procedures in adults due to hallucinations and delirium (11,12). However, there are studies (13)(14)(15)(16) in which ketamine is used in adult day-care patients during various interventional procedures such as (dental, gynecological, and endoscopic). There is no analgesic effect of midazolam, but its use makes amnesia after the procedure (17).…”