Canpolat Dilek Gunay, Yildirim Mustafa Denizhan, Aksu Recep, Kutuk Nukhet, Alkan Alper, Cantekin Kenan
Dilek Gunay Canpolat, Anesthesiologist, Department of Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey.
Mustafa Denizhan Yildirim, Anesthesiologist, Department of Pediatric Dentistry, Erciyes University Faculty of Dentistry, Kayseri, Turkey.
Pak J Med Sci. 2016 May-Jun;32(3):682-7. doi: 10.12669/pjms.323.9834.
Dental treatments cannot bealways performed under local anesthesia inpediatric non-cooperative patients. For this purpose, differentanesthetic techniques have been applied to increase patient comport to dental treatments.
Sixty children classified as ASA I-II, between aged 3 to 9, who were scheduled to undergo tooth extraction, were enrolled for this randomized study. Group K received 1 mg/kg ketamine, Group P received 1 mg/kg propofol, and Group KP received 0.5 mg/kg propofol plus 0.5 mg/kg ketamine intravenously for anesthesia induction.
Recovery time was significantly lower in Group P than Group KP. No significant differences were found between groups regarding HR, before and after the induction, at tenth minute. Fifth minute's HR was higher in Group K than Group KP. 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 P and Group KP than in Group K at fifth minute.
Although ketamine, propofol and ketamine-propofol combination are effective for sedation in tooth extraction in pediatric patients, propofol may be an excellent alternative, with the shortest recovery, no nausea and vomiting, and reasonable surgical satisfaction.
对于小儿不合作患者,牙科治疗无法始终在局部麻醉下进行。为此,已应用不同的麻醉技术来提高患者对牙科治疗的耐受性。
本随机研究纳入了60名年龄在3至9岁、ASA分级为I-II级、计划接受拔牙的儿童。K组静脉注射1mg/kg氯胺酮,P组静脉注射1mg/kg丙泊酚,KP组静脉注射0.5mg/kg丙泊酚加0.5mg/kg氯胺酮进行麻醉诱导。
P组的苏醒时间显著低于KP组。诱导前、诱导后第10分钟时,各组心率无显著差异。第5分钟时,K组心率高于KP组。平均动脉压(MAP)值在基线、诱导前、诱导后及第10分钟时相似,而在第5分钟时,P组和KP组的值显著低于K组。
虽然氯胺酮、丙泊酚及氯胺酮-丙泊酚联合用药对小儿拔牙镇静有效,但丙泊酚可能是一个极佳的选择,其苏醒时间最短,无恶心呕吐,且手术满意度合理。