Propofol-Remifentanil Versus Propofol-Ketamine for Third Molar Surgery

A study titled “Comparison of Propofol-Remifentanil Versus Propofol-Ketamine Deep Sedation for Third Molar Surgery” appears in the 2012 Anesthesia Progress journal.

The authors of the study set out to better determine what anesthetic to provide during third molar (aka wisdom teeth) surgery.

In the study, two drug combinations for use as deep sedation during oral surgery were evaluated.

Patients in a control group received a continuous intravenous infusion of propofol-remifentanil,  and patients in an experimental group received a continuous intravenous infusion of propofol-ketamine. This study was double blind in that neither patients nor surgeons were aware of which treatment was given.

In this study, 37 patients  were monitored while sedated for respiratory, heart rate, and blood pressure stability. Emergence from the effects of anesthesia and total recovery time were recorded. In addition, patients and surgeons were both asked to rate their satisfaction with the anesthetic given.

It was found that those patients who received the ketamine treatment took longer to emerge from the effects of the anesthesia. For those who received ketamine, the average emergence time was 13.6 minutes while those who received remifentanil  had an average emergence time of  7.1 minutes. The recovery period for ketamine patients was an average of 42.9 minutes while those with remifentanil recovered in an average 24.5 minutes.

An increase in heart rate was noted among patients receiving the ketamine treatment. Regarding, satisfaction of treatment, both patients and surgeons were very satisfied.

While the sample size in this study is a bit small, the more rapid recovery from the propofol-remifentanil combination makes it a more ideal deep sedative for wisdom teeth extractions performed in dental offices. However, ketamine is cheaper and remifentanil  is more costly.

Source: Kyle J. Kramer, Steven Ganzberg, Simon Prior, Robert G. Rashid. Comparison of Propofol-Remifentanil Versus Propofol-Ketamine Deep Sedation for Third Molar Surgery. Anesthesia Progress, vol. 59, issue 3, 107, 2012.

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