A comparative study of anesthetic effects of ketamine, propofol and propofol-ketamine combination in tooth extraction of children
Dilek Günay Canpolat1, Mustafa Denizhan Yıldırım1, Recep Aksu2, Nükhet Kütük3, Alper Alkan3
1Anesthesiologist, Erciyes University Faculty of Dentistry, Kayseri, Turkey
2Department of Anesthesiology, Erciyes University Medical Faculty, Kayseri, Turkey
3Department of Oral Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
BACKGROUND: Majority of dental treatments can be performed under local anesthesia. However, this is not always possible for pediatric non-cooperated patients with severe anxiety. For this purpose, different anesthetic tecnique have been applied to increase patient comport to dental treatments. METHODS: Sixty children classified as ASA physical status I-II, between aged 3 to 9, who were scheduled to undergo tooth extraction with sedation, were enrolled for a prospective, randomized study. Patients were randomly divided into 3 groups. Group 1 received 1 mg/kg ketamine, Group 2 received 1 mg/kg propofol, and Group 3 received 0.5 mg/kg propofol-0.5 mg/kg ketamine intravenously for anesthesia induction. Additional doses were repeated when necessary. RESULTS: Recovery time was significantly lower in Group 2 (8.2±4.6 min) than Group 3 (15.5±7.1 min) (p=0.001). Surgeon satisfaction was significantly higher in Group 3 than the others (p= 0.003). No significant differences were found between groups regarding HR, before and after the induction, at tenth minute (p>0.05). However, fifth minute’s HR was significantly higher in Group 1 than Group 3 (p=0.020). 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 2 and Group 3 than in Group 1 at fifth minute (p<0.001). Additional drug repetitions was similar in Group 1 and 2, however it was significantly higher in Group 1 than Group 3 (p= 0.057, p=0.009). CONCLUSION: Ketamine-propofol combination is a better option than ketamine or propofol alone, for deep sedation in pediatric dental extraction due to a better hemodynamic stability, less additional drug repetitions, less nausea-vomiting.
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