Comparative evaluation of bispectral index system after sedation with midazolam and propofol combined with remifentanil versus ketamine in uncooperative during dental procedures

Abstract

Background: Proper analgesic agents should be used in combination with sedative agents.
Remifentanil is a synthetic narcotic/analgesic agent with a short duration effect and decreases the
risk of apnea during recovery. Bispectral index system (BIS) is a new noninvasive technique for the
evaluation of the depth of sedation. The aim of present clinical trial was to evaluate and compare
the effi cacy of intravenous sedation with propofol/midazolam/remifentanil (PMR) in comparison to
propofol/midazolam/ketamine (PMK) for dental procedures in children 3-7 years of age.
Materials and Methods: In this clinical trial, 32 healthy uncooperative children who were
candidates for dental treatments under sedation were randomly divided into two groups. Intravenous
sedation was induced with PMR in one group and with PMK in the other group. After injection and
during procedure BIS index, heart rate and respiratory rate, blood pressure, and oxygen saturation
was evaluated every 5 min. After the procedure, recovery time was measured. Data were analyzed
with ANOVA, Friedman, Wilcoxon, and t-test.
Results: The BIS value was signifi cantly low in ketamin group (P = 0.003) but respiratory rates
and heart rates were same in both groups with no statistical difference (P = 0.884, P = 0.775). The
recovery time was signifi cantly shorter in remifentanil group (P = 0.008 and P = 0.003).
Conclusion: It can be concluded that intravenous sedation technique with PMR combination
induces effective and safe sedation, with less pain and more forgetfulness and a shorter recovery
time for children 3-7 years of age during dental procedures.

Key Words: Bispectral index, ketamine, midazolam, propofol, remifentanil