Abstract
Amaç: Günübirlik anestezi çocuk hastalarda dental girişimlerin uygulanabilirliğini artırmıştır. Bu çalışmadaki amacımız derin sedasyon altında dental tedavi uygulanan çocuk olgularda kullanılan ilaç kombinasyonlarını, güvenilirlik ve etkinlik bakımından karşılaştırmaktır.
Gereç ve Yöntemler: Derin sedasyon ile dental tedavi uygulanan ASA I-III, 4-11 yaş arasında 88 çocuk çalışmaya dahil edildi. Kliniğimizin rutin protokolüne göre derin sedasyon uygulanan olguların anestezi formlarında kayıt altına alınan kalp hızı, kan basıncı, oksijen saturasyonu, indüksiyonda kullanılan ajanlar (fentanil, ketamin), total propofol tüketim miktarları, yan etkileri, taburcu edilme zamanları ve ilk oral alım zamanları kaydedilip istatistiksel olarak değerlendirildi.
Bulgular: Değerlendirme sonucunda hastaların yaş, cinsiyet, kilo, ASA skorları, ek hastalık varlığı, kilo, anestezi süresi, diş tedavi süresi, dolgu sayısı, çekim sayısı ve lokal anestezi uygulamaları karşılaştırıldığında istatistiksel olarak anlamlı farklılık saptanmadı. Propofol tüketim miktarının, fentanil kullanılan grupta (Grup F),ketamin kullanılan gruba (Grup K) oranla istatistiksel olarak daha fazla olduğu anlamlı olarak tespit edildi (p<0.001). Taburcu olma süresi ketamin kullanılan grupta fentanil kullanılan gruba kıyasla istatistiksel olarak anlamlı şekilde daha uzun bulundu (p<0.001) Ketamin grubunda oral alıma başlangıç süresi fentanil grubuna kıyasla daha geç oldu (p<0.001). Hemodinamik parametreler karşılaştırıldığında Grup K ‘e kıyasla Grup F ‘de daha fazla düşüş izlendi (p<0.05). Oksijen saturasyonu gruplar arası farklılık göstermedi.
Sonuç: Dental tedavi için kullanılan her iki anestezi protokolü de güvenilir ve etkindir. Ketamin grubunda daha düşük propofol tüketimi gözlenirken, fentanil grubunda hastaların daha erken taburcu olduğu gözlenmiştir. Sonuç olarak çocuklarda derin sedasyon altında diş tedavisi için her iki kombinasyonun da tercih edilebileceği kanısındayız.
Keywords
References
- 1. Somri M, Parisinos CA, Kharouba J, Cherni N, Smidt A, Abu Ras Z, et al. Optimising the dose of oral midazolam sedation for dental procedures in children: A prospective, randomised, and controlled study. Int J Paediatr Dent 2012;22:271-9.
- 2. ASA. Continuum of depth of sedation: Definition of general anesthesia and levels of sedation/analgesia. on October 15 2014.
- 3. Şenel AC, Altintaş NY, Şenel FÇ, Pampu A, Tosun E, Üngör C, et al. Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: Failure and complications. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:592-6.
- 4. Marshall SI, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth Analg 1999;88:508-17.
- 5. American Academy on Pediatric Dentistry Clinical Affairs Committee-Behavior Management S; American Academy on Pediatric Dentistry Council on Clinical A. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 2008;30:125- 33.
- 6. Antunes DE, Viana KA, Costa PS, Costa LR. Moderate sedation helps improve future behavior in pediatric dental patients-a prospective study. Braz Oral Res 2016; 30:e107
- 7. Attri JP, Sharan R, Makkar V, Gupta KK, Khetarpal R, Kataria AP. Conscious sedation: Emerging trends in pediatric dentistry. Anesth Essays Res 2017;11:277-81.
- 8. Arora S. Combining ketamine and propofol (“ketofol”) for emergency department procedural sedation and analgesia: A review. West J Emerg Med 2008;9:20-3.
- 9. Vallejo MC, Romeo RC, Davis DJ, Ramanathan S. Propofolketamine versus propofol-fentanyl for outpatient laparoscopy: Comparison of postoperative nausea, emesis, analgesia, and recovery. J Clin Anesth 2002;14:426-31.
- 10. Crea F RA, Genovese O, Tortorolo L, Zorzi G, Chiaretti A. Safety and efficacy of two protocols for sedation in pediatric oncology procedures. Cent Eur J Med 2008:77-82.
- 11. Turk HS, Aydogmus M, Unsal O, Isil CT, Citgez B, Oba S, et al. Ketamine versus alfentanil combined with propofol for sedation in colonoscopy procedures: a randomized prospective study. Turk J Gastroenterol 2014;25:644-9.
- 12. Botero CA, Smith CE, Holbrook C, Chavez AM, Snow NJ, Hagen JF, et al. Total intravenous anesthesia with a propofol-ketamine combination during coronary artery surgery. J Cardiothorac Vasc Anesth 2000;14:409-15.
- 13. Disma N, Astuto M, Rizzo G, Rosano G, Naso P, Aprile G, et al. Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children. Eur J Anaesthesiol 2005;22:848-52.
- 14. Hollman GA, Schultz MM, Eickhoff JC, Christenson DK. Propofolfentanyl versus propofol alone for lumbar puncture sedation in children with acute hematologic malignancies: Propofol dosing and adverse events. Pediatr Crit Care Med 2008;9:616-22.
- 15. Wathen JE, Roback MG, Mackenzie T, Bothner JP. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, emergency department trial. Ann Emerg Med 2000;36:579-88.
- 16. Willman EV, Andolfatto G. A prospective evaluation of “ketofol” (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med 2007;49:23-30.
- 17. Akin A, Guler G, Esmaoglu A, Bedirli N, Boyaci A. A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. J Clin Anesth 2005;17:187- 90.
Abstract
Objective: Daily anesthesia has increased the applicability of dental interventions in children. Our aim in this study was to compare the safety and efficacy of drug combinations used in childhood dental treatment under deep sedation.
Material and Methods: A total of 88 children aged 4-11 years ASA I-III that received deep sedation were included in the study. According to the routine protocol of our clinic, the heart rate, blood pressure, oxygen saturation, induction agents (fentanyl, ketamine), total propofol consumption, side effects, discharge time and first oral intake time were recorded in the anesthesia forms of deep sedation cases and then statistically evaluated.
Results: There was no statistically significant difference between the patients’ age, sex, weight, ASA scores, presence of additional disease, weight, duration of anesthesia, duration of dental treatment, number of fillings, number of shots and local anesthesia data. The amount of propofol consumed was found to be statistically significantly higher in group F using fentanyl than in group K using ketamine (p <0.001). The time to discharge was longer with ketamine than with fentanyl (p <0.001). Oral intake in the ketamine group was later than the fentanyl group (p <0.001). When haemodynamic parameters were compared, Group F showed more decrease than Group K (p <0.05).
Conclusion: Both anesthesia protocols used for dental treatment are reliable and effective. Patients in the fentanyl group were discharged earlier and lower propofol consumption was observed in the ketamine group. In conclusion, we believe that both combinations may be used for dental treatment under deep sedation in children.
Keywords
References
- 1. Somri M, Parisinos CA, Kharouba J, Cherni N, Smidt A, Abu Ras Z, et al. Optimising the dose of oral midazolam sedation for dental procedures in children: A prospective, randomised, and controlled study. Int J Paediatr Dent 2012;22:271-9.
- 2. ASA. Continuum of depth of sedation: Definition of general anesthesia and levels of sedation/analgesia. on October 15 2014.
- 3. Şenel AC, Altintaş NY, Şenel FÇ, Pampu A, Tosun E, Üngör C, et al. Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: Failure and complications. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:592-6.
- 4. Marshall SI, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth Analg 1999;88:508-17.
- 5. American Academy on Pediatric Dentistry Clinical Affairs Committee-Behavior Management S; American Academy on Pediatric Dentistry Council on Clinical A. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 2008;30:125- 33.
- 6. Antunes DE, Viana KA, Costa PS, Costa LR. Moderate sedation helps improve future behavior in pediatric dental patients-a prospective study. Braz Oral Res 2016; 30:e107
- 7. Attri JP, Sharan R, Makkar V, Gupta KK, Khetarpal R, Kataria AP. Conscious sedation: Emerging trends in pediatric dentistry. Anesth Essays Res 2017;11:277-81.
- 8. Arora S. Combining ketamine and propofol (“ketofol”) for emergency department procedural sedation and analgesia: A review. West J Emerg Med 2008;9:20-3.
- 9. Vallejo MC, Romeo RC, Davis DJ, Ramanathan S. Propofolketamine versus propofol-fentanyl for outpatient laparoscopy: Comparison of postoperative nausea, emesis, analgesia, and recovery. J Clin Anesth 2002;14:426-31.
- 10. Crea F RA, Genovese O, Tortorolo L, Zorzi G, Chiaretti A. Safety and efficacy of two protocols for sedation in pediatric oncology procedures. Cent Eur J Med 2008:77-82.
- 11. Turk HS, Aydogmus M, Unsal O, Isil CT, Citgez B, Oba S, et al. Ketamine versus alfentanil combined with propofol for sedation in colonoscopy procedures: a randomized prospective study. Turk J Gastroenterol 2014;25:644-9.
- 12. Botero CA, Smith CE, Holbrook C, Chavez AM, Snow NJ, Hagen JF, et al. Total intravenous anesthesia with a propofol-ketamine combination during coronary artery surgery. J Cardiothorac Vasc Anesth 2000;14:409-15.
- 13. Disma N, Astuto M, Rizzo G, Rosano G, Naso P, Aprile G, et al. Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children. Eur J Anaesthesiol 2005;22:848-52.
- 14. Hollman GA, Schultz MM, Eickhoff JC, Christenson DK. Propofolfentanyl versus propofol alone for lumbar puncture sedation in children with acute hematologic malignancies: Propofol dosing and adverse events. Pediatr Crit Care Med 2008;9:616-22.
- 15. Wathen JE, Roback MG, Mackenzie T, Bothner JP. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, emergency department trial. Ann Emerg Med 2000;36:579-88.
- 16. Willman EV, Andolfatto G. A prospective evaluation of “ketofol” (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med 2007;49:23-30.
- 17. Akin A, Guler G, Esmaoglu A, Bedirli N, Boyaci A. A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. J Clin Anesth 2005;17:187- 90.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | ORIGINAL ARTICLES |
| Authors | |
| Publication Date | March 21, 2019 |
| Submission Date | November 9, 2017 |
| Published in Issue | Year 2019 Volume: 13 Issue: 1 |
The publication language of Turkish Journal of Pediatric Disease is English.
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