Effects of the addition of low-dose ketamine to propofol anesthesia in the dental procedure for intellectually disabled patients

Abstract

Background This study aimed to examine whether the combination of low-dose ketamine and propofol in deep sedation is clinically useful in controlling the behavior in intellectually disabled patients who are typically extremely noncooperative during dental procedures. Methods A total of 107 extremely noncooperative intellectually disabled adult patients were analyzed. In all patients, deep sedation was performed using either propofol alone (group P) or using a combination of propofol and 0.2 mg/kg or 0.4 mg/kg ketamine (groups PK0.2 and PK0.4, respectively). The procedures were performed in the order of insertion of nasal cannula into the nostril, attachment of mouth gag, and mouth cleaning and scaling. The frequency of patient movement during the procedures, mean arterial pressure, heart rate, peripheral oxygen saturation, recovery time, discharge time, and postoperative nausea and vomiting were examined. Results The three groups were significantly different only in the frequency of patient movement upon stimulation during single intravenous injection of propofol and scaling. Conclusion For propofol deep sedation, in contrast to intravenous injection of propofol alone, prior intravenous injection of low-dose ketamine (0.4 mg/kg) is clinically useful because it neither affects recovery, nor causes side effects and can suppress patient movement and vascular pain during procedures.

Effectiveness and Safety of Intravenous Sedation with Propofol in Non-Operating Room Anesthesia (NORA) for Dental Treatment in Uncooperative Paediatric Patients

“…Paediatric dentistry has provided several pharmaceutical and non-pharmaceutical methods for controlling children's behavior; however, non-pharmaceutical and conscious sedative methods may not work for extremely uncooperative children. Therefore, for patients with severe anxiety and for intellectually disabled patients, intravenous sedation is often required for dental procedures [21].…”

“…Propofol, which activates inhibitory GABA receptors, ensures fast recovery and it should be considered appropriate for intravenous sedation in paediatric patients submitted to ambulatory dental treatment [21].…”

Safety and efficacy of target controlled infusion administration of propofol and remifentanil for moderate sedation in non-hospital dental practice

“…Several studies have reported that combining different types of drugs has synergistic effects on drug sedative potential [ 13 14 ]. Therefore, the addition of opioid narcotics reduces the required dose of propofol significantly [ 15 16 17 ]. Remifentanil is a synthetic short-acting opioid used to induce and maintain sedation [ 18 ].…”

Ketamine-propofol (ketofol) in procedural sedation: a narrative review

“…Deep sedation is performed using propofol alone (loading dose, 1.2 mg/kg; infusion, 5–8 mg/kg/h) or in combination with ketamine (0.2 or 0.4 mg/kg). Prior addition of low-dose ketamine (0.4 mg/kg) suppresses patient movement and vascular pain with no side effects [ 22 ].…”

“…For ketofol infusion, 0.5 mg/kg of ketofol is administered as a loading dose, followed by continuous infusion at a dose of 2.4–3.6 mg/kg/h [ 25 ]. In the case of ketofol mixed at a 1:2 or 1:4 ratio instead of a 1:1 ratio and when low-dose ketamine is used, ketamine can be continuously administered at 0.5–2.0 mg/kg/h and propofol at 3–8 mg/kg/h [ 22 27 40 41 42 ]. However, since the propofol dose for sedation is 1.5–4.5 mg/kg/h, continuous infusion at a dose above this can cause respiratory depression.…”