What's the Ideal Sedative for Oral Surgery?

Oral surgery patients who received a propofol-remifentanil cocktail had shorter emergence from anesthesia, quicker recoveries and faster discharges than patients who received a propofol-ketamine combination, according to a study published in the journal Anesthesia Progress.

Researchers who assessed the effects of the drug combinations on 37 patients who had wisdom teeth extracted say patients who received remifentanil emerged from anesthesia in 7 minutes, compared to patients in the ketamine group, who emerged in 13.5 minutes. Ketamine patients averaged nearly 43 minutes in the PACU, while remifentanil patients were ready for discharge in 25 minutes.

None of the patients reported adverse behavioral effects such as dysphoria or hallucinations, notes the study. Patients in the ketamine group, however, reported mild post-op euphoria, which resolved before discharge. While the researchers concede the sensation could have been a mild form of emergence delirium, patients didn't perceive it as a negative occurrence. Patients in the remifentanil group did not experience the sensation; they instead appeared unimpaired or mildly sedated.

Only 1 patient — who happened to be in the ketamine group — experienced PONV, although the study notes that may have been caused by poor compliance with instructions to bite down firmly on surgical-site dressings following the procedure. The heart rates of ketamine patients increased during sedation, but there was no significant difference in oxygen saturation levels between the 2 groups. Surgeons were reportedly equally satisfied with both drug combinations.

While remifentanil costs, on average, $4.90 more than ketamine per case, the researchers note the cost difference may be offset by the extra time needed to monitor and recover the ketamine patients, and the additional amount of propofol required for the group.

Daniel Cook