Comparison of three different ketofol proportions in children undergoing dental treatment

Abstract

Aim and Background: Sedation is gaining popularity among dental procedures in children. Ketamine and propofol mixture, known as ketofol, is one of the promising choices in sedation protocols; however, there is no consensus on the exact ratio of ketamine plus propofol especially in dental practice. The aim of present study was to compare perioperative side effect profiles, recovery profiles, and satisfaction rates of both parents’ and dentists’ following three different ratio of ketofol mixtures in children undergoing dental treatment.

Materials and Methods: Three study groups each containing 30 children scheduled for dental treatment were created. Following anesthesia induction with 5% sevoflurane, 50% nitrous oxide mixture in 50% oxygen, 1 mg/kg bolus ketofol dose was administered. Patients in Group 1 received ketofol as a 1:1 mixture, patients in Group 2 received 1:2 ketofol while in Group 3; 1:4 ketofol was administered at a constant dose of 100 μg/kg/min. Additional doses of the ketofol solution at the same concentration with infused solutions in groups (0.5 mg/kg from either 1:1, 1:2, or 1:4 proportions) were administered if required. Perioperative vital signs, side effects, postoperative side effects, recovery durations, parents’ and dentists’ satisfaction levels were compared between groups.

Results: There were no significant differences between groups in terms of perioperative vital signs and side effects. Depth of sedation, dentists’ satisfaction levels and postoperative side effects –myoclonus, hypersalivation and tachycardia were significantly higher in Group 1. Parents’ satisfaction was highest in Group 3, however, necessity of additional doses and dissatisfaction of dentists’ were found highest in this group. Mean duration of recovery recorded in Group 3 was shortest compared with other groups.

Conclusion: Decreased ketamine doses in ketofol mixture was related with decreased side effect profile, high parents’ satisfaction with fast recovery, however, dentists’ satisfaction was lower. In this context, results of present study indicated that ketofol mixture of 1:2 ratio was more reliable choice than others when all investigated parameters evaluated simultaneously.

Keywords: Dentistry, dentists’ satisfaction, ketamine, ketofol, parents’ satisfaction, propofol, sedation