Enhancements to propofol anesthesia for oral and maxillofacial surgery

Abstract

During the latter part of the 20th century the ultra short acting barbiturates thiopental and methohexital were the “work horse” intravenous agents utilized in hospital operating rooms and oral and maxillofacial surgery offices for outpatient anesthesia. However, since its introduction in 1989 the substituted phenolic compound propofol has replaced the barbiturates in many oral surgery offices and operating rooms throughout the world. Two of propofol’s primary attributes are a short serum half-life and rapid biotransformation and elimination. These characteristics lead to the shortened recovery time which is so essential for outpatient anesthesia. However, propofol has a number of other desirable characteristics as well. It is associated with a markedly diminished incidence of laryngospasms and is well tolerated in both renal and hepatic insufficiency. In addition, propofol has anti-emetic properties, and emergence from a propofol anesthetic is associated with a profound feeling of well-being which boosts patient acceptance dramatically. An interesting addition to propofol anesthesia for an office-based anesthetic is concomitant administration of low-dose ketamine. At low doses, in combination with propofol, there is little if any tendency for the patient to develop emergence delirium or hypertension. The properties of the two anesthetics complement one another and add a new dimension of “smoothness” to office-based intravenous anesthesia. These agents can be administered via either infusion pump or a small incremental bolus (or “bump”) technique. In addition, propofol has also been used for self-administered sedation utilizing PCA machines (Patient Controlled Analgesia). This presentation will review the pertinent pharmacology of propofol and ketamine as well as methods for administering these agents in a safe and comfortable fashion for the surgeon-anesthetist and patient alike. References Bryson HM, Fulton BR, Faulds D: Propofol: An update of its use in anesthesia and conscious sedation. Drugs 50:513, 1995 Smith I, White PF, Nathanson M, et al: Propofol: An update on its clinical use. Am Soc Anesthesiol 81:1005, 1994 Haas DA, Harper DG: Ketamine: A review of its pharmacological properties and use in ambulatory anesthesia. American Dental Society of Anesthesiology. Anesth Prog 39:31–68