Sedation Applications in Pedodontics Procedures: Which One Should We Choose?: A retrospective analysis

Sedation Applications in Pedodontics Procedures: Which One Should We Choose?: A retrospective analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sedation Applications in Pedodontics Procedures: Which One Should We Choose?: A retrospective analysis Fatih Oluş, Hüseyin Babun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5052525/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Oct, 2025 Read the published version in BMC Oral Health → Version 1 posted 6 You are reading this latest preprint version Abstract Background: The use of sedation in the field of pediatric dentistry is becoming increasingly prevalent. While general anesthesia is perceived as a safer alternative, the appropriate use of sedatives, in conjunction with a well-trained team, can effectively mitigate the risks associated with sedation. Our study aims to identify safe drug combinations for prolonged sedation. Methods: This study was conducted in the Operating Room of the Faculty of Dentistry at Akdeniz University. It encompassed 126 patients, classified as ASA 1-2, aged between 3 and 12 years, who underwent dental treatment with sedation support in the Department of Pedodontics from May to December 2022. The patients were categorized into three groups: 1) Ketamine, 2) Propofol-Ketamine (PK), and 3) Dexmedetomidine-Ketamine (DK). During the procedures, vital signs, the requirement for additional doses, complications, and interventions were meticulously documented. Additionally, the Ramsay Sedation Score (RSS), dentist satisfaction during the procedure, recovery time, and Aldrete scores for the postoperative 1st and 2nd hours were also recorded. Results: There were no statistically significant differences between the groups in terms of age, gender, mean weight, and ASA. The minimum requirement for additional doses was recorded in the DK group. Respiratory depression, apnea, hypoxia, and related maneuvers were most frequently observed in the PK group. DK group had minimum requirement for airway suction event. Hypertension and tachycardia were most frequently observed in the K group, while hypotension and bradycardia were most frequently recorded in the DK group. PONV were most common in the K group in which high ketamine doses were administered. RSS was highest in the DK group. The longest recovery times were observed in the DK group. 1st hour Aldrete scores were lower in the DK group. Dentists reached the highest level of satisfaction in the DK group. Conclusions: This retrospective study provides comparative insights into three sedation regimens for pediatric dental procedures. The dexmedetomidine-ketamine combination demonstrated superior intraoperative stability and fewer respiratory complications, though recovery was prolonged. These findings may guide clinicians in selecting appropriate sedation strategies to improve safety and procedural outcomes in cases involving shared airway management. Sedation Sedoanalgesia Pedodontics Dexmedetomidine Ketamine Propofol Figures Figure 1 Figure 2 1. Introduction Pediatric sedation is an increasingly important procedure to minimize anxiety and pain preferred in various medical fields such as emergency department, dentistry, gastrointestinal endoscopy, and radiology. Among the main goals of sedation are anxiolysis, analgesia, amnesia and facilitation of performing the procedure in a safe and effective way ( 1 ). According to the American Society of Anesthesiologists (ASA) classification in 2002, four levels of sedation was defined ranging from minimal sedation (anxiolysis) and moderate sedation (conscious sedation) to deep sedation and general anesthesia ( 2 ). Minimal sedation refers to the situation in which a patient responds normally to verbal stimuli, and respiratory and cardiovascular function is unaffected. In moderate sedation, depression of consciousness, or dissociation is observed and the patient is able to respond purposefully to verbal commands and/or tactile stimuli. Deep sedation refers that the patient has a depressed level of consciousness and cannot be easily aroused, but, responds purposefully following repeated or painful stimuli. Deep sedation may require support for maintaining a patent airway. And at the deepest stage, general anesthesia, the consciousness is completely lost, and the patient is not arousable to any stimuli. The patient is not able to maintain independent ventilatory function and positive pressure ventilation is required. The level of sedation may be decided depending on several factors including pain level, invasiveness and length of the procedure, or cooperation of the patient. In the field of pediatric dentistry, a significant number of children demands mild or moderate sedation to gain control of their behavior during their dental treatments ( 3 ). The complexity of pediatric sedation during dental treatments is heightened due to the anesthesiologist needing to share the airway with dentists, coupled with the aspiration risks posed by secretions, blood, and irrigation solutions in the oral cavity during procedures. The potential risks associated with sedation can be largely mitigated through a thorough preoperative evaluation and judicious selection of patients. This initial assessment should encompass the patient's medical and anesthesia history, existing diseases, and a detailed examination of the airway. Implementing appropriate measures in response to potential risks is crucial in preventing a range of adverse outcomes. Beyond the Mallampati classification, it is essential to pay additional attention to risk factors such as a short neck, small mandible, dysmorphic features, limited mouth opening, a large tongue, and enlarged tonsils. The necessity for a skilled anesthesiologist becomes particularly paramount in pediatric patients, especially those below a certain age. Along with the above-mentioned risks and complexities, it should be kept in mind that, pediatric patients are at higher risk of unintentionally moving to a deeper state of sedation than desired ( 4 ). Therefore, the determination of sedation indications is of critical importance. Caution should be exercised in establishing sedation indications, and the scope of these indications should be maintained as narrowly as possible. Various medications such as nitrous oxide, midazolam, ketamine, propofol, and dexmedetomidine have been utilized in combination or alone for induction of pediatric sedation. Although more than one drug group is used together for optimal sedation, previous studies have shown that combined use of sedative agents may increase the side effect potentials of drugs even more ( 5 ). In the realm of pediatric sedation, a variety of agents, including nitrous oxide, midazolam, ketamine, propofol, and dexmedetomidine, are utilized either as standalone treatments or in combination. Although more than one drug group is used together for optimal sedation, previous studies have shown that this can increases the side effect potentials of drugs even more ( 5 ). Till date a consensus on the optimal drug group and their combinations for pediatric sedation has yet to be established. Ketamine and propofol have been employed successfully for many years in sedation practices, whether used individually or in combination. Although ketamine alone safely provides dissociative anesthesia, it has been also reported that combination of propofol and ketamine may provide more effective sedation when compared to ketamine alone ( 6 ). Although the ketamine-propofol combination has been shown to provide effective sedation, several studies have highlighted its association with respiratory complications, emphasizing the need for careful patient monitoring and vigilant perioperative management. ( 7 , 8 ). As well several studies have also demonstrated that dexmedetomidine creates a sedation similar to physiological sleep without causing respiratory depression ( 9 – 11 ). This aspect renders dexmedetomidine particularly valuable in pediatric dental patients who require deep sedation and have limited airway control, offering a distinct advantage in such clinical scenarios. While various sedative combinations have been studied, most research has been limited to either single-agent protocols or short-duration procedures. Comparative data on the most widely used combinations, particularly under conditions that reflect real clinical complexity, remain scarce. To our knowledge, this is the first study to compare ketamine, Propofol-Ketamine (PK) and -Dexmedetomidine-Ketamine (DK) combinations specifically in pediatric dental patients. Furthermore, this study distinguishes itself by evaluating these sedation regimens in the context of extended-duration procedures, which are commonly encountered in pediatric dentistry, in contrast to the majority of prior research that has concentrated on short-term sedation scenarios. 2. Methods The present study included patients, who underwent sedated dental treatments between May to December 2022 at Department of Pedodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkiye. The Helsinki Declaration of Ethics for Medical Research Involving Human Subjects was followed and Clinical Research Ethics Committee of the Akdeniz University, Antalya, Turkiye approved the study (Approval Number: KAEK-251). This manuscript was prepared according to the CONSORT guidelines ( 12 ). All patients were informed about the content and the aim of the study and verbal and written informed consents were obtained from the patients and, when applicable, their families or legal guardians, in accordance with ethical guidelines for clinical data acquisition. Patients This retrospective study included patients, aged between 3 and 12 years with ASA physical statuses 1 and 2, who underwent sedated dental treatments between May to December 2022 at Department of Pedodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkiye. Exclusion criteria encompassed patients who received general anesthesia, those diagnosed with mental retardation, individuals with ASA 3 status or higher, and cases with incomplete file data Dental procedures were performed either by experienced pediatric dentistry faculty members or by senior residents under supervision. Operator distribution was balanced across the sedation groups. Anesthesia Protocol We analyzed data from three patient groups who were administered routine procedures involving ketamine, a combination of ketamine and propofol infusion, and a mixture of ketamine and dexmedetomidine infusion. In our clinic, the primary consideration in selecting a drug group is the estimated duration of the procedure. If the dentists anticipate that the procedure will take less than one hour, ketamine is administered alone. Only patients with standardized anesthesia drugs and techniques were included in the analysis. All participants were premedicated with atropine (0.01 mg/kg) for its antisecretory effect and midazolam (0.1 mg/kg) for anxiolysis. Nasal cannulas were employed, and nasal oxygen support was provided as necessary. Following standard monitoring procedures involving electrocardiogram, pulse oximetry, and noninvasive arterial blood pressure measurement, the ketamine group (K) received an initial dose of 2 mg/kg, with subsequent doses of 1 mg/kg administered as required. For the propofol and ketamine infusion group (PK), a propofol infusion commenced at 2.5 mg/kg/hour after an initial 2 mg/kg dose of ketamine. In the dexmedetomidine and ketamine group (DK), dexmedetomidine was given at a loading dose of 1 mcg/kg in the first 10 minutes following the ketamine administration, then infused at a rate of 1 mcg/kg/hour. Both the propofol and dexmedetomidine infusion groups received additional ketamine doses of 0.5 mg/kg as necessary. A decrease in oxygen saturation below 92% on pulse oximetry was considered indicative of hypoxia; nasal oxygen support was provided, and the oxygen flow rate required to maintain saturation above 92% was recorded in liters per minute. Throughout the procedures, vital signs, additional dosing requirements, complications, and interventions were meticulously recorded. A respiratory rate falling below 8 breaths per minute was classified as apnea, prompting appropriate maneuvers. Blood pressure readings 20% above or below the basal level were considered indicative of hypertension or hypotension, respectively. Pulse rates exceeding 140 bpm were categorized as tachycardia, and rates below 60 bpm as bradycardia. An airway suction event (ASE) was defined as the need for deep suctioning by the anesthesiology team due to the accumulation of secretions at or near the level of the vocal cords. These events were distinct from routine intraoral suctioning performed by the dental team and were typically identified by signs of airway compromise such as audible congestion or reflexive coughing. ASEs did not include aspiration following vomiting, which was recorded as a separate complication. The Ramsay Sedation Score (RSS) was assessed during the procedure, and dentist satisfaction was gauged post-procedure. Additionally, recovery times and Aldrete scores were calculated and noted for the 1st and 2nd postoperative hours. At the end of each procedure, the attending dentist was asked to rate their satisfaction with the sedation quality and overall working conditions. Responses were recorded using a 3-point Likert-type scale: “Satisfied”, “Neutral”, or “Dissatisfied”. 2.1. Statistical Analysis Descriptive statistics, including the number, percentage, mean, standard deviation, median, minimum, and maximum values of the data, were presented. The reliability of the scales utilized in the study was rigorously tested. As an initial step in statistical analysis, we assessed the normality assumption using the Shapiro-Wilk test and verified the homogeneity of variances with the Levene test. For comparing the means of three or more independent groups with a normal distribution, the ANOVA test was employed. In cases where a normal distribution was not observed, the Kruskal-Wallis test was applied. To compare the means of three or more dependent groups with a normal distribution, the Repeated Measures ANOVA was used, while the Friedman's test was utilized in the absence of a normal distribution. Post-hoc analyses, including Bonferroni and Adjusted Bonferroni tests, were conducted to identify the groups contributing to significant differences. In exploring the relationships between categorical variables, Pearson's Chi-Square analysis was applied when the sample size assumption was met (expected value ≥ 5). Conversely, Fisher's Exact test was employed when this assumption was not satisfied (expected value < 5). All analyses were performed using the IBM® SPSS® Version 23 software. Sample Size Due to the retrospective nature of this study and the use of existing patient records that met the inclusion criteria, it was not feasible to perform a formal a priori power analysis based on specific expected effect sizes for the primary outcomes (e.g., sedation success, respiratory complications). Therefore, a sample size estimation was conducted using G*Power version 3.1.9.2, based on the comparison of three independent groups at a 95% confidence level (α = 0.05) and 95% statistical power (1 − β = 0.95) ( 13 ). In line with similar studies ( 14 ), the calculation was based on the outcome variable that yielded the highest required sample size, to ensure adequate power across multiple clinical endpoints. As a result, the minimum required sample size was determined to be 29 patients per group. 3. Results 112 patients were included in this study. There were 3 groups. (1-Ketamine(n:40), 2-Propofol-Ketamine(n:41), 3-Dexmedetomidine-Ketamine(n:45)). The mean age of the patients in our study was 5.8±1.99 years, with the youngest being 3 years old and the oldest 11 years (Table 1). Of these, 62 (49.2%) were females, and 64 (50.8%) were males (Table 1). In terms of the ASA classification, 112 patients (88.9%) were categorized as ASA 1, while 14 patients (11.1%) were classified as ASA 2 (Table 1). Our statistical analysis revealed no significant relationships or differences in terms of age, weight, gender, and ASA classification across the different drug groups (p > 0.05) Table 1: Demographic characteristics according to drug groups K (n=40) PK (n=41) DK (n=45) Test Statistic p Age, Mean ±SD(M) 5,54±1,94(5,5) 5,77±1,82(5,5) 6,22±2,18(6) 2,188 0,335 Weight(kg), Mean ±SD 19,53±7,48(17,5) 21,1±8,68(20) 21,64±8,56(20) 1,182 0,554 Gender, n (%) Girl 19(47,5) 22(53,7) 21(46,7) 0,488 0,784 Boy 21(52,5) 19(46,3) 24(53,3) ASA, n (%) 0 38(95) 36(87,8) 38(84,4) 2,482† 0,297 1 2(5) 5(12,2) 7(15,6) *p<0,05 and †Fisher’s Exact test, ASA (American Society of Anesthesiologists Classification), K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine) Regarding the types of procedures performed, patients in the K group underwent 150 fillings, 9 root canal treatments, and 65 extractions. In the PK group, 216 fillings, 28 root canals, 68 extractions, and 3 amputations were performed. The DK group received 258 fillings, 44 root canal treatments, 73 extractions, and 6 amputations. Ketamine addition A statistically significant correlation was found between the necessity for additional doses of ketamine and the drug groups (p < 0.05). Within the K group, the majority of cases required 3 to 4 additional doses. For the PK group, the additional dose requirement predominantly ranged between 2 to 4 times, while 26 patients (57.8%) did not need any extra dose, and the requirement was limited to one additional dose for the remaining in the DK group. The average number of additional doses was calculated as 3.40±1.32 for the K group, 2.44±1.38 for the PK group, and 0.46±0.62 for the DK group (Table 2). Table 2: Drug groups with the requirement for additional doses of Ketamine K (n=40) PK(n=41) DK (n=45) Test Statistic p Additional Dose, n (%) 0 1(2,5) 4(9,8) 26(57,8) 91,575† 0,000* 1 3(7,5) 7(17,1) 18(40) 2 2(5) 8(19,5) 0(0) 3 16(40) 13(31,7) 1(2,2) 4 12(30) 8(19,5) 0(0) 5 3(7,5) 0(0) 0(0) 6 3(7,5) 1(2,4) 0(0) Additional Dose, Mean.±SD (M) 3,40±1,32(3,00) 2,44±1,38(3,00) 00,46±0,62(0,00) 69,857 0,000* *p<0,05 and †Fisher’s Exact test Nasal O2 support A statistically significant association was observed between the requirement for nasal O2 support and the different drug groups (p < 0.05). In the K and DK groups, there was generally no need for nasal O2 support. In contrast, the PK group predominantly required nasal O2 support at flow rates of 3 and 4 l/min (Table 3). Jaw thrust and head tilt/chin lift maneuvers Furthermore, a statistically significant relationship was found between the implementation of Jaw Thrust (JT) and Head Tilt/Chin Lift (HT/CL) maneuvers and the drug groups (p < 0.05). While these maneuvers were mostly not necessary in the K and DK groups, their frequency of application was notably higher in the PK group (Table 3). Airway suction event (ASE) A statistically significant correlation was identified between the need for ASE and the various drug groups (p < 0.05). The requirement for ASE was lower in the PK and DK groups compared to the K group, with the DK group exhibiting the least need for this intervention (Table 3). Additionally, our analysis revealed no statistically significant relationships or differences in terms of mask ventilation support and endotracheal intubation across the different drug groups (p > 0.05). Table 3: Maneuvers according to drug groups K (n=40) PK (n=41) DK (n=45) Test Statistic p Nasal O2, n (%) None 33(82,5) 9(22) 41(91,1) 65,523† 0,000* 1 1(2,5) 0(0,0) 1(2,2) 2 5(12,5) 6(14,6) 1(2,2) 3 1(2,5) 13(31,7) 0(0,0) 4 0(0,0) 13(31,7) 2(4,4) HT/ CL, n (%) - 39(97,5) 31(75,6) 45(100) 16,453† 0,000* + 1(2,5) 10(24,4) 0(0) JT, n (%) - 30(75) 25(61) 45(100) 20,632 0,000* + 10(25) 16(39) 0(0) MV, n (%) - 40(100) 40(97,6) 45(100) 1,885† 0,642 + 0(0) 1(2,4) 0(0) ASE , n (%) - 14(35) 23(56,1) 41(91,1) 29,141 0,000* + 26(65) 18(43,9) 4(8,9) ETI, n (%) - 39(97,5) 41(100) 45(100) 1,935† 0,326 + 1(2,5) 0(0) 0(0) *p<0,05 and †Fisher’s Exact test, K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine), HT/CL(Head Tilt/Chin Lift), JT(Jaw Thrust), MV(Mask Ventilation), ASE(Airway suction event), ETI(Endotracheal Intubation) Cardio-respiratory changes Statistically significant differences were observed among the drug groups in terms of apnea, hypoxia, hypotension, hypertension, bradycardia, tachycardia, and postoperative nausea and vomiting (PONV) (p < 0.05) (Table 4). Apnea was noted in 7 patients (17.1%) in the PK group, but it was not observed in the K and DK groups. Hypoxia was primarily absent in the K and DK groups, while a higher incidence was recorded in the PK group (Table 4). Hypotension was most frequently (20%) identified in the DK group. Bradycardia occurred in 14 patients (31.1%) in the DK group but was not present in the K and PK groups (Table 4). Hypertension was observed in 6 patients (15%) in the K group, but not in the PK and DK groups. Tachycardia and PONV were predominantly observed in the K group (Table 4). No statistically significant correlation was found in terms of bronchospasm across the drug groups (p > 0.05). Table 4: Complications according to drug groups K (n=40) PK (n=41) DK (n=45) Test Statistic p Apnea, n (%) - 40(100) 34(82,9) 45(100) 12,308† 0,001* + 0(0) 7(17,1) 0(0) Hypoxia, n (%) - 33(82,5) 10(24,4) 41(91,1) 49,588 0,000* + 7(17,5) 31(75,6) 4(8,9) Hypotension, n (%) - 40(100) 38(92,7) 36(80) 10,116† 0,004* + 0(0) 3(7,3) 9(20) Hypertension, n (%) - 34(85) 41(100) 45(100) 10,452† 0,001* + 6(15) 0(0) 0(0) Bradycardia, n (%) - 40(100) 41(100) 31(68,9) 26,435† 0,000* + 0(0) 0(0) 14(31,1) Tachycardia, n (%) - 24(60) 40(97,6) 44(97,8) 31,647 0,000* + 16(40) 1(2,4) 1(2,2) Bronchospasm, n (%) - 38(95) 40(97,6) 45(100) 2,155† 0,207 + 2(5) 1(2,4) 0(0) PONV, n (%) - 20(50) 40(97,6) 44(97,8) 43,058 0,000* + 20(50) 1(2,4) 1(2,2) *p<0,05 and †Fisher’s Exact test, K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine), PONV(Postoperative Nausea and Vomiting) An analysis of the changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) over time across the drug groups revealed a general decreasing trend, with the exception of the K group. In the K group, the preoperative values (SBP: 100.07±12.12, DBP: 60.82±19.86) were slightly lower than those observed at the 5-minute mark (SBP: 103.03±12.29, DBP: 62.78±9.93), though this difference was not statistically significant. Following the 5th minute, a downward trend similar to the other groups was observed. The DK group exhibited the most pronounced decrease in both SBP and DBP values (Fig. 1). Regarding the mean beats per minute (BPM) values over time, a decreasing trend was observed in all drug groups except for the K group. In the K group, the preoperative BPM mean (104.2±12.16) was slightly lower than the value at the 5th minute (110.53±10.39); however, this difference was not statistically significant. After the 5th minute, a downward trend was noted, aligning with the trends observed in the other groups. The DK group exhibited the most substantial decrease, particularly between the 5th minute mean (102.8±9.71) and the 10th minute mean (90.98±9.28), (Fig. 2). Ramsay Sedation Score Statistically significant differences were observed between the Ramsay Sedation Score (RSS) and the different drug groups (p < 0.05). In the K and PK groups, the sedation score predominantly ranged between 4 and 5 points. In contrast, the DK group most frequently achieved a sedation score of 6 points (Table 5). Table 5: Ramsay Sedation Score according to drug groups K (n=40) PK (n=41) DK (n=45) Test Statistic p RSS, n (%) 4 15(37,5) 11(26,8) 0(0) 67,823 0,000* 5 19(47,5) 27(65,9) 8(17,8) 6 6(15) 3(7,3) 37(82,2) *p<0,05 and K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine), RSS(Ramsay Sedation Score) Duration of sedation A statistically significant difference was observed in the mean sedation times across the drug groups (p < 0.05). Notably, significant differences were found when comparing the K group with both the PK and DK groups, as well as between the PK and DK groups (p = 0.001, p = 0.000, p = 0.019). Although the mean sedation times of the PK and DK groups were similar, they were both statistically significantly longer than that of the K group (Table 6). Recovery time A statistically significant difference was observed in the mean recovery times among the drug groups (p < 0.05). Significant differences were evident between the DK group and both the K and PK groups (p = 0.000 for both comparisons). While the mean recovery times for the K and PK groups were similar, they were statistically significantly shorter than the mean recovery time of the DK group (Table 6). Table 6: Sedation and recovery times according to drug groups K (n=40) PK (n=41) DK (n=45) Test Statistic p Sedation Time, Mean.±SD (M) 54,58±16,38(54) a 70,63±19,29(71) b 82,69±23,37(83) c 20,887 0,000* Recovery Time, Mean.±SD (M) 8,95±2,5(9) a 9,05±2,62(9) a 34,71±6,94(35) b 446,324 0,000* *p<0,05 and K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine) Aldrete score Statistically significant associations were identified between the Aldrete scores at the 1st and 2nd hours and the drug groups (p < 0.05). In the K and PK groups, the Aldrete scores during the 1st hour predominantly ranged between 9 and 10. In contrast, in the DK group, the scores during the 1st hour were chiefly between 6, 7, and 8. (Table 7). At the second hour, Aldrete scores were calculated to be 10 points for all patients in the PK group and for 95% of the K group. In the DK group, 17 patients (37.8%) scored 9, while 28 patients (62.2%) scored 10 (Table 7). Table 7: Aldrete scores according to drug groups K (n=40) PK (n=41) DK (n=45) Test Statistic p 1 st hour n (%) 6 0(0) 0(0) 6(13,3) 109,701† 0,000* 7 0(0) 0(0) 10(22,2) 8 0(0) 2(4,9) 25(55,6) 9 18(45) 16(39) 4(8,9) 10 22(55) 23(56,1) 0(0) 2 nd hour, n (%) 9 2(5) 0(0) 17(37,8) 28,559 0,000* 10 38(95) 41(100) 28(62,2) *p<0,05 and †Fisher’s Exact test, K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine) Dentist satisfaction A statistically significant correlation was established between dentist satisfaction and the drug groups (p < 0.05). Dentist satisfaction was predominantly higher in the DK group, whereas neutral and dissatisfied responses were more frequently observed in the K and PK groups. No statistically significant difference in satisfaction levels was noted between the K and PK groups (Table 8). Table 8: Dentist satisfaction according to drug groups K (n=40) PK (n=41) DK (n=45) Test Statistic p Dentist satisfaction, n (%) Neutral 11(27,5) 14(34,1) 4(8,9) 33,217 0,000* Dissatisfied 12(30,0) 12(29,3) 0(0,0) Satisfied 17(42,5) 15(36,6) 41(91,1) *p<0,05 and K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine) 4. Discussion Sedation in pediatric patients is increasingly utilized, particularly in dental treatments where airway sharing with the dental team adds procedural complexity. The risk of aspirating fluids or foreign materials further complicates sedation management. Therefore, pediatric dental sedation requires the expertise of an anesthesia team experienced in dental procedures to ensure safety and effectiveness. This study provides both methodological and clinical value by comparing sedative regimens based on their side-effect profiles and suitability for extended procedures—an area not widely covered in current literature. Its relevance is particularly notable in pediatric dentistry, where precise airway control is essential and must be managed by skilled anesthesiologists. In the K group, additional ketamine doses were commonly required, likely due to the absence of continuous infusion. Similarly, the PK group showed a higher need for supplemental dosing compared to the DK group. This may be explained by the deeper and more stable sedation achieved with dexmedetomidine bolus loading in the DK group. Evans et al. reported progressive upper airway narrowing with increasing anesthesia depth during propofol use (15). In line with the literature, apnea and hypoxia—presumably related to propofol—were more frequently observed in the PK group in our study (16). Consequently, oxygen support and airway maneuvers were required more often in this group. While dexmedetomidine may also cause respiratory depression at high doses (17-19). such complications were less frequent in our DK group, likely due to appropriate dosing. In our study, the DK group showed a lower incidence of respiratory complications compared to the PK group, likely due to careful dosing that avoided the higher levels associated with respiratory depression. These results highlight the clinical value of dexmedetomidine in settings where respiratory risk is a concern. Kim G. et al. noted that respiratory depression with ketamine is extremely rare unless administered rapidly at high doses (20). Consistent with this, apnea, hypoxia, and related interventions were less frequent in the K group. The antisecretory effect of dexmedetomidine, previously described in the literature, likely contributed to the lower incidence of increased salivation and ASE in the DK group (17, 21, 22). In contrast, excessive secretion and frequent need for ASEs were most commonly observed in the K group, consistent with ketamine’s known secretory effects (23). Byron C. et al. highlighted the hypotensive effects of dexmedetomidine (21, 24). In line with this, our study found a higher incidence of hypotension in the DK group, while no such cases were recorded in the K group. Dexmedetomidine’s bradycardic effect has been well-documented in the literature (21, 24), and our findings align with this, showing a significantly higher incidence of bradycardia in the DK group. Despite the tachycardic properties of atropine and ketamine used in premedication, a gradual heart rate decline was observed following dexmedetomidine bolus administration. In some cases, initial tachycardia induced by ketamine was effectively counteracted by dexmedetomidine, ultimately resulting in bradycardia. Overall, in the DK group, the combined sympatholytic effect of dexmedetomidine appeared to override the transient tachycardic response to premedication. Ketamine’s hypertensive and tachycardic effects are well-established in the literature (23). In our study, hypertension was most frequently observed in the K group, likely due to the higher cumulative doses of ketamine compared to the PK and DK groups, where propofol and dexmedetomidine's hypotensive effects may have provided balance. Similarly, tachycardia was common in the K group, which may be attributed not only to ketamine’s sympathomimetic properties but also to the use of atropine as an antisecretory premedication. The routine use of atropine—necessitated by the unavailability of glycopyrrolate in our setting—may have further contributed to the elevated heart rate. PONV is a well-known adverse effect associated with ketamine administration (23, 25, 26). In our study, the K group exhibited the highest incidence of PONV, which can likely be attributed to the use of repeated high doses of ketamine. In contrast, the lower PONV rates observed in the PK and DK groups may be explained by the established antiemetic properties of propofol and the emerging evidence supporting the antiemetic effects of dexmedetomidine (27-29). Furthermore, analysis of RSS demonstrated that the DK group achieved deeper levels of sedation, with significantly higher scores than those observed in the other groups. Recovery times were found to be significantly longer in the DK group. Despite the intraoperative advantages observed with the DK combination, such as hemodynamic stability and reduced respiratory complications, the recovery time was notably longer compared to the other groups. This may be attributed to the pharmacological profile of dexmedetomidine, particularly its longer elimination half-life and sedative persistence (21). From a clinical perspective, future strategies such as adjusting the timing of drug cessation or modifying infusion protocols may help mitigate this delay without compromising intraoperative safety. The lower Aldrete scores observed in the DK group during the first postoperative hour were consistent with delayed recovery. However, by the second hour, differences among the groups were no longer statistically significant, likely due to the complete clearance of sedatives. These findings suggest that, despite initial delays, outpatient procedures can still be completed safely without requiring hospital admission. Dentists reported the highest level of procedural satisfaction in the DK group. This was primarily attributed to enhanced patient immobility and the absence of intraoperative complications requiring anesthetic intervention. Notably, although prolonged recovery is an important consideration for anesthesiologists and caregivers, it did not negatively impact dentist satisfaction. This highlights that intraoperative stability and workflow efficiency may carry greater weight than recovery duration in the assessment of procedural quality by dental practitioners. The use of sedation in pediatric dentistry continues to expand, offering an alternative to general anesthesia, which—despite its perceived safety—carries significant risks such as bronchospasm and laryngospasm during intubation and extubation. These potential complications underscore the importance of selecting appropriate sedative regimens tailored to both the procedure and patient profile, administered under optimal clinical conditions. Ketamine has a well-established safety profile in pediatric sedation, with predictable pharmacodynamics and manageable adverse effects. In this study, we aimed to highlight the relative benefits of two sedative combinations—ketamine with propofol and ketamine with dexmedetomidine—each designed to offset the limitations of ketamine monotherapy. While propofol is known to enhance sedation depth, it poses an increased risk of respiratory depression and blunted protective reflexes, especially in intraoral procedures where the airway is shared. In contrast, dexmedetomidine offers a favorable respiratory safety profile, making it a compelling adjunct. When combined with ketamine, it attenuates ketamine-induced tachycardia, hypertension, and hypersalivation, offering improved intraoperative conditions. Nevertheless, dexmedetomidine’s prolonged recovery time presents a notable clinical challenge. This drawback, however, can be partially addressed by timing the discontinuation of infusion in coordination with the pedodontic team. Additionally, although its cost may limit routine use, the overall economic impact must be weighed against the potential for complications, increased interventions, and delayed discharges associated with alternative agents. This study has several limitations that should be acknowledged. First, its retrospective design limited the ability to control variables such as drug cessation timing and patient selection. Second, objective monitoring tools such as bispectral index (BIS) and capnography were not utilized, which may have restricted the accuracy of sedation depth and respiratory status assessments. Additionally, outcome assessment was not blinded, which may have introduced observer bias. Another potential limitation is the involvement of multiple operators with varying levels of clinical experience. Although cases were evenly distributed between faculty members and senior residents, individual differences in technique and behavior management may have influenced sedation quality and procedural outcomes. Future prospective studies incorporating standardized sedation protocols, objective monitoring tools, and blinded assessments are warranted to validate and expand upon these findings. Based on our findings, specific recommendations can be made regarding the selection of sedation regimens tailored to procedural requirements and patient characteristics: – Ketamine monotherapy may be appropriate for short-duration procedures (<45 minutes) in healthy, cooperative patients (ASA I), where rapid recovery and cost-effectiveness are prioritized. – Propofol–Ketamine combination (PK) appears preferable for moderate-duration procedures (45–60 minutes) that require a deeper level of sedation, provided that close monitoring for respiratory depression is available. – Dexmedetomidine-Ketamine combination (DK) is best suited for long-duration procedures (>60 minutes) or those involving shared airway challenges, particularly in patients with increased secretion, elevated aspiration risk, or hemodynamic sensitivity. Tailoring sedation strategies to procedural complexity and individual patient profiles is essential for maximizing both safety and clinical efficiency in pediatric dental settings. In conclusion, this retrospective study offers valuable comparative insights into three sedation approaches—ketamine alone, ketamine with propofol, and ketamine with dexmedetomidine—for pediatric dental procedures requiring extended sedation. Among these, the dexmedetomidine-ketamine combination (DK group) provided superior intraoperative stability, fewer respiratory complications, and a lower incidence of airway secretions, thereby enhancing procedural conditions and dentist satisfaction. However, its association with prolonged recovery underscores the need for careful perioperative coordination. Despite certain limitations, including its retrospective design, this study addresses a critical gap in the literature by evaluating sedation practices in pediatric dental procedures involving complex airway management. These findings may assist clinicians in optimizing sedation protocols and selecting appropriate drug combinations to enhance procedural success and patient safety. Abbreviations ASA: American Society of Anesthesiologists RSS: Ramsay Sedation Score HT/CL: Head Tilt/Chin Lift JT: Jaw Thrust MV: Mask Ventilation ASE: Airway Suction Event ETI: Endotracheal Intubation PONV: Postoperative Nausea and Vomiting SBP: Systolic Blood Pressure and DBP: Diastolic Blood Pressure BPM: Beats Per Minute BIS: Bispectral Index Declarations Ethics approval and consent to participate Clinical Research Ethics Committee of the Akdeniz University, Antalya, Turkiye approved the study (Approval Number: KAEK-251). All patients were informed about the content and the aim of the study and verbal and written informed consents were obtained from the patients and, when applicable, their families or legal guardians, in accordance with ethical guidelines for clinical data acquisition. Clinical trial number Not applicable. (In accordance with the guidelines set forth by the International Committee of Medical Journal Editors (ICMJE), this retrospective study, which involved the collection of data from patient files and anesthesia records, does not require the assignment of a number from the Clinical Trials (NCT) registry.) Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article. Data supporting this research article are available from the corresponding authors on reasonable request. Competing interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ contributions F. Oluş designed the study. H. Babun acquired and analyzed the data. F. Oluş and H. Babun performed the sedations. F. Oluş and H. Babun drafted and edited manuscript. All authors have read and agreed to the published version of this manuscript. Acknowledgements None declared. References Williams MR, Nayshtut M, Hoefnagel A, McKeown A, Carlson DW, Cravero J, et al. Efficacy outcome measures for pediatric procedural sedation clinical trials: an ACTTION systematic review. Anesthesia & Analgesia. 2018;126(3):956-67. ASA. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004-17. Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatric dentistry. 2016;38(4):13E-39E. Stern J, Pozun A. Pediatric procedural sedation. 2021. Coté CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics. 2000;106(4):633-44. Alletag MJ, Auerbach MA, Baum CR. Ketamine, Propofol, and Ketofol Use for Pediatric Sedation. Pediatric Emergency Care. 2012;28(12):1391-5. Shaaban AR, Kamal S, Okasha MM. Comparison of dexmedetomidine versus propofol for maintenance of anesthesia during invasive procedures in pediatric oncology patients: a controlled randomized double-blind study. Ain Shams Journal of Anesthesiology. 2014;7(2). Joshi AB, Shankaranarayan UR, Hegde A, Manju R. To Compare the efficacy of two intravenous combinations of drugs ketamine–propofol vs ketamine–dexmedetomidine for sedation in children undergoing dental treatment. International Journal of Clinical Pediatric Dentistry. 2020;13(5):529. Nelson Laura E, Lu J, Guo T, Saper Clifford B, Franks Nicholas P, Maze M. The α2-Adrenoceptor Agonist Dexmedetomidine Converges on an Endogenous Sleep-promoting Pathway to Exert Its Sedative Effects. Anesthesiology. 2003;98(2):428-36. Doze VA, Chen BX, Maze M. Dexmedetomidine produces a hypnotic-anesthetic action in rats via activation of central alpha-2 adrenoceptors. Anesthesiology. 1989;71(1):75-9. Hsu Y-W, Cortinez Luis I, Robertson Kerri M, Keifer John C, Sum-Ping Sam T, Moretti Eugene W, et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology. 2004;101(5):1066-76. Cuschieri S. The STROBE guidelines. Saudi journal of anaesthesia. 2019;13(Suppl 1):S31-S4. Cohen J. Statistical power analysis for the behavioral sciences: Academic press; 2013. Heard C, Burrows F, Johnson K, Joshi P, Houck J, Lerman J. A Comparison of Dexmedetomidine-Midazolam with Propofol for Maintenance of Anesthesia in Children Undergoing Magnetic Resonance Imaging. Anesthesia & Analgesia. 2008;107(6):1832-9. Evans Russell G, Crawford Mark W, Noseworthy Michael D, Yoo S-J. Effect of Increasing Depth of Propofol Anesthesia on Upper Airway Configuration in Children. Anesthesiology. 2003;99(3):596-602. Aun C. New iv agents. British journal of anaesthesia. 1999;83(1):29-41. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77(6):1125-33. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59(2):263-8. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, Amnestic, and Analgesic Properties of Small-Dose Dexmedetomidine Infusions. Anesthesia & Analgesia. 2000;90(3):699-705. Kim G, Green SM, Denmark TK, Krauss B. Ventilatory Response during Dissociative Sedation in Children—A Pilot Study. Academic Emergency Medicine. 2003;10(2):140-5. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54(12):1136-42. Naaz S, Ozair E. Dexmedetomidine in current anaesthesia practice- a review. J Clin Diagn Res. 2014;8(10):Ge01-4. Sinner B, Graf BM. Ketamine. In: Schüttler J, Schwilden H, editors. Modern Anesthetics. Berlin, Heidelberg: Springer Berlin Heidelberg; 2008. p. 313-33. Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology. 1992;77(6):1134-42. Tsze DS, Steele DW, Machan JT, Akhlaghi F, Linakis JG. Intranasal Ketamine for Procedural Sedation in Pediatric Laceration Repair: A Preliminary Report. Pediatric Emergency Care. 2012;28(8):767-70. Fallahinejad Ghajari M, Ansari G, Soleymani AA, Shayeghi S, Fotuhi Ardakani F. Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3-6-year-old Uncooperative Dental Patients. J Dent Res Dent Clin Dent Prospects. 2015;9(2):61-5. Okawa H, Ono T, Hashiba E, Tsubo T, Ishihara H, Hirota K. Decreased postoperative nausea and vomiting with dexmedetomidine after off-pump coronary artery bypass grafting. Critical Care. 2011;15(1):P351. Kim SY, Kim JM, Lee JH, Song BM, Koo BN. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. BJA: British Journal of Anaesthesia. 2013;111(2):222-8. Borgeat A, Stirnemann HR. [Antiemetic effect of propofol]. Anaesthesist. 1998;47(11):918-24. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Oct, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Accepted 28 Aug, 2025 Reviews received at journal 09 Jun, 2025 Reviewers agreed at journal 03 Jun, 2025 Reviewers invited by journal 03 Jun, 2025 Submission checks completed at journal 03 Jun, 2025 First submitted to journal 02 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5052525","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":470785114,"identity":"ea8f4788-9aaf-441e-ba70-c54c13dac385","order_by":0,"name":"Fatih Oluş","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Fatih","middleName":"","lastName":"Oluş","suffix":""},{"id":470785115,"identity":"f41086c1-0066-4a72-859d-79156a09fcca","order_by":1,"name":"Hüseyin Babun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACAyiZwCABpD8AMRs7KVoYZ4C0MBOlhQGihZkHxCSkxVwi/eFjnoI7efyze8we2/zaJs/HzMD44WMObi2WM3KMjXkMnhVL3Dljbpzbd9uwjZmBWXLmNjwOu5HDJs1jcDix4UaOmXRuz21GoBY2Zl68WtKf/wZpmQ/SYtlz254ILQlmzCAtG0BaGH7cTiSs5cwbY8k5BoeLDe8cK5Psbbid3MbM2IzfL8fTH3548+dwntzt5m0SP/7ctp3f3nzww0c8WkCAiQfGYmwDkw341YOU/IAz/xBUPApGwSgYBSMQAABl9FJ+9TT9AgAAAABJRU5ErkJggg==","orcid":"","institution":"Akdeniz University","correspondingAuthor":true,"prefix":"","firstName":"Hüseyin","middleName":"","lastName":"Babun","suffix":""}],"badges":[],"createdAt":"2024-09-08 12:11:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5052525/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5052525/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-025-06871-w","type":"published","date":"2025-10-08T15:58:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86784743,"identity":"53975edc-7e8b-4377-af6a-5e6b92eb83a1","added_by":"auto","created_at":"2025-07-15 14:00:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":131768,"visible":true,"origin":"","legend":"\u003cp\u003eChanges of SBP and DBP means of drug groups according to time\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5052525/v1/545a1c0d6505dcb265c6395a.png"},{"id":86783302,"identity":"9cd067ee-a015-461f-b8a8-bbf7c3f64704","added_by":"auto","created_at":"2025-07-15 13:52:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":138454,"visible":true,"origin":"","legend":"\u003cp\u003eChanges of BPM and SpO2 means of drug groups according to time\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5052525/v1/6cb5ff13129594efa0ab565c.png"},{"id":93419756,"identity":"4a70fccb-7a1c-4360-9811-d3505c297626","added_by":"auto","created_at":"2025-10-13 16:07:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1409938,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5052525/v1/32faa25c-08ef-4359-9045-a0ae2e61c440.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSedation Applications in Pedodontics Procedures: Which One Should We Choose?: A retrospective analysis\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePediatric sedation is an increasingly important procedure to minimize anxiety and pain preferred in various medical fields such as emergency department, dentistry, gastrointestinal endoscopy, and radiology. Among the main goals of sedation are anxiolysis, analgesia, amnesia and facilitation of performing the procedure in a safe and effective way (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the American Society of Anesthesiologists (ASA) classification in 2002, four levels of sedation was defined ranging from minimal sedation (anxiolysis) and moderate sedation (conscious sedation) to deep sedation and general anesthesia (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Minimal sedation refers to the situation in which a patient responds normally to verbal stimuli, and respiratory and cardiovascular function is unaffected. In moderate sedation, depression of consciousness, or dissociation is observed and the patient is able to respond purposefully to verbal commands and/or tactile stimuli. Deep sedation refers that the patient has a depressed level of consciousness and cannot be easily aroused, but, responds purposefully following repeated or painful stimuli. Deep sedation may require support for maintaining a patent airway. And at the deepest stage, general anesthesia, the consciousness is completely lost, and the patient is not arousable to any stimuli. The patient is not able to maintain independent ventilatory function and positive pressure ventilation is required.\u003c/p\u003e \u003cp\u003eThe level of sedation may be decided depending on several factors including pain level, invasiveness and length of the procedure, or cooperation of the patient. In the field of pediatric dentistry, a significant number of children demands mild or moderate sedation to gain control of their behavior during their dental treatments (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe complexity of pediatric sedation during dental treatments is heightened due to the anesthesiologist needing to share the airway with dentists, coupled with the aspiration risks posed by secretions, blood, and irrigation solutions in the oral cavity during procedures. The potential risks associated with sedation can be largely mitigated through a thorough preoperative evaluation and judicious selection of patients. This initial assessment should encompass the patient's medical and anesthesia history, existing diseases, and a detailed examination of the airway. Implementing appropriate measures in response to potential risks is crucial in preventing a range of adverse outcomes. Beyond the Mallampati classification, it is essential to pay additional attention to risk factors such as a short neck, small mandible, dysmorphic features, limited mouth opening, a large tongue, and enlarged tonsils. The necessity for a skilled anesthesiologist becomes particularly paramount in pediatric patients, especially those below a certain age. Along with the above-mentioned risks and complexities, it should be kept in mind that, pediatric patients are at higher risk of unintentionally moving to a deeper state of sedation than desired (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, the determination of sedation indications is of critical importance. Caution should be exercised in establishing sedation indications, and the scope of these indications should be maintained as narrowly as possible.\u003c/p\u003e \u003cp\u003eVarious medications such as nitrous oxide, midazolam, ketamine, propofol, and dexmedetomidine have been utilized in combination or alone for induction of pediatric sedation. Although more than one drug group is used together for optimal sedation, previous studies have shown that combined use of sedative agents may increase the side effect potentials of drugs even more (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the realm of pediatric sedation, a variety of agents, including nitrous oxide, midazolam, ketamine, propofol, and dexmedetomidine, are utilized either as standalone treatments or in combination. Although more than one drug group is used together for optimal sedation, previous studies have shown that this can increases the side effect potentials of drugs even more (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Till date a consensus on the optimal drug group and their combinations for pediatric sedation has yet to be established. Ketamine and propofol have been employed successfully for many years in sedation practices, whether used individually or in combination. Although ketamine alone safely provides dissociative anesthesia, it has been also reported that combination of propofol and ketamine may provide more effective sedation when compared to ketamine alone (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although the ketamine-propofol combination has been shown to provide effective sedation, several studies have highlighted its association with respiratory complications, emphasizing the need for careful patient monitoring and vigilant perioperative management. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). As well several studies have also demonstrated that dexmedetomidine creates a sedation similar to physiological sleep without causing respiratory depression (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This aspect renders dexmedetomidine particularly valuable in pediatric dental patients who require deep sedation and have limited airway control, offering a distinct advantage in such clinical scenarios.\u003c/p\u003e \u003cp\u003eWhile various sedative combinations have been studied, most research has been limited to either single-agent protocols or short-duration procedures. Comparative data on the most widely used combinations, particularly under conditions that reflect real clinical complexity, remain scarce.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study to compare ketamine, Propofol-Ketamine (PK) and -Dexmedetomidine-Ketamine (DK) combinations specifically in pediatric dental patients. Furthermore, this study distinguishes itself by evaluating these sedation regimens in the context of extended-duration procedures, which are commonly encountered in pediatric dentistry, in contrast to the majority of prior research that has concentrated on short-term sedation scenarios.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThe present study included patients, who underwent sedated dental treatments between May to December 2022 at Department of Pedodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkiye. The Helsinki Declaration of Ethics for Medical Research Involving Human Subjects was followed and Clinical Research Ethics Committee of the Akdeniz University, Antalya, Turkiye approved the study (Approval Number: KAEK-251). This manuscript was prepared according to the CONSORT guidelines (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). All patients were informed about the content and the aim of the study and verbal and written informed consents were obtained from the patients and, when applicable, their families or legal guardians, in accordance with ethical guidelines for clinical data acquisition.\u003c/p\u003e \u003cp\u003e \u003cem\u003ePatients\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThis retrospective study included patients, aged between 3 and 12 years with ASA physical statuses 1 and 2, who underwent sedated dental treatments between May to December 2022 at Department of Pedodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkiye. Exclusion criteria encompassed patients who received general anesthesia, those diagnosed with mental retardation, individuals with ASA 3 status or higher, and cases with incomplete file data Dental procedures were performed either by experienced pediatric dentistry faculty members or by senior residents under supervision. Operator distribution was balanced across the sedation groups.\u003c/p\u003e \u003cp\u003e \u003cem\u003eAnesthesia Protocol\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWe analyzed data from three patient groups who were administered routine procedures involving ketamine, a combination of ketamine and propofol infusion, and a mixture of ketamine and dexmedetomidine infusion. In our clinic, the primary consideration in selecting a drug group is the estimated duration of the procedure. If the dentists anticipate that the procedure will take less than one hour, ketamine is administered alone. Only patients with standardized anesthesia drugs and techniques were included in the analysis. All participants were premedicated with atropine (0.01 mg/kg) for its antisecretory effect and midazolam (0.1 mg/kg) for anxiolysis. Nasal cannulas were employed, and nasal oxygen support was provided as necessary. Following standard monitoring procedures involving electrocardiogram, pulse oximetry, and noninvasive arterial blood pressure measurement, the ketamine group (K) received an initial dose of 2 mg/kg, with subsequent doses of 1 mg/kg administered as required. For the propofol and ketamine infusion group (PK), a propofol infusion commenced at 2.5 mg/kg/hour after an initial 2 mg/kg dose of ketamine. In the dexmedetomidine and ketamine group (DK), dexmedetomidine was given at a loading dose of 1 mcg/kg in the first 10 minutes following the ketamine administration, then infused at a rate of 1 mcg/kg/hour. Both the propofol and dexmedetomidine infusion groups received additional ketamine doses of 0.5 mg/kg as necessary. A decrease in oxygen saturation below 92% on pulse oximetry was considered indicative of hypoxia; nasal oxygen support was provided, and the oxygen flow rate required to maintain saturation above 92% was recorded in liters per minute. Throughout the procedures, vital signs, additional dosing requirements, complications, and interventions were meticulously recorded. A respiratory rate falling below 8 breaths per minute was classified as apnea, prompting appropriate maneuvers. Blood pressure readings 20% above or below the basal level were considered indicative of hypertension or hypotension, respectively. Pulse rates exceeding 140 bpm were categorized as tachycardia, and rates below 60 bpm as bradycardia. An airway suction event (ASE) was defined as the need for deep suctioning by the anesthesiology team due to the accumulation of secretions at or near the level of the vocal cords. These events were distinct from routine intraoral suctioning performed by the dental team and were typically identified by signs of airway compromise such as audible congestion or reflexive coughing. ASEs did not include aspiration following vomiting, which was recorded as a separate complication. The Ramsay Sedation Score (RSS) was assessed during the procedure, and dentist satisfaction was gauged post-procedure. Additionally, recovery times and Aldrete scores were calculated and noted for the 1st and 2nd postoperative hours. At the end of each procedure, the attending dentist was asked to rate their satisfaction with the sedation quality and overall working conditions. Responses were recorded using a 3-point Likert-type scale: \u0026ldquo;Satisfied\u0026rdquo;, \u0026ldquo;Neutral\u0026rdquo;, or \u0026ldquo;Dissatisfied\u0026rdquo;.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Statistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics, including the number, percentage, mean, standard deviation, median, minimum, and maximum values of the data, were presented. The reliability of the scales utilized in the study was rigorously tested. As an initial step in statistical analysis, we assessed the normality assumption using the Shapiro-Wilk test and verified the homogeneity of variances with the Levene test. For comparing the means of three or more independent groups with a normal distribution, the ANOVA test was employed. In cases where a normal distribution was not observed, the Kruskal-Wallis test was applied. To compare the means of three or more dependent groups with a normal distribution, the Repeated Measures ANOVA was used, while the Friedman's test was utilized in the absence of a normal distribution. Post-hoc analyses, including Bonferroni and Adjusted Bonferroni tests, were conducted to identify the groups contributing to significant differences. In exploring the relationships between categorical variables, Pearson's Chi-Square analysis was applied when the sample size assumption was met (expected value\u0026thinsp;\u0026ge;\u0026thinsp;5). Conversely, Fisher's Exact test was employed when this assumption was not satisfied (expected value\u0026thinsp;\u0026lt;\u0026thinsp;5). All analyses were performed using the IBM\u0026reg; SPSS\u0026reg; Version 23 software.\u003c/p\u003e \u003cp\u003e \u003cem\u003eSample Size\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDue to the retrospective nature of this study and the use of existing patient records that met the inclusion criteria, it was not feasible to perform a formal a priori power analysis based on specific expected effect sizes for the primary outcomes (e.g., sedation success, respiratory complications). Therefore, a sample size estimation was conducted using G*Power version 3.1.9.2, based on the comparison of three independent groups at a 95% confidence level (α\u0026thinsp;=\u0026thinsp;0.05) and 95% statistical power (1\u0026thinsp;\u0026minus;\u0026thinsp;β\u0026thinsp;=\u0026thinsp;0.95) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn line with similar studies (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), the calculation was based on the outcome variable that yielded the highest required sample size, to ensure adequate power across multiple clinical endpoints. As a result, the minimum required sample size was determined to be 29 patients per group.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e112 patients were included in this study. There were 3 groups. (1-Ketamine(n:40), 2-Propofol-Ketamine(n:41), 3-Dexmedetomidine-Ketamine(n:45)).\u003c/p\u003e\n\u003cp\u003eThe mean age of the patients in our study was 5.8\u0026plusmn;1.99 years, with the youngest being 3 years old and the oldest 11 years (Table 1). Of these, 62 (49.2%) were females, and 64 (50.8%) were males (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn terms of the ASA classification, 112 patients (88.9%) were categorized as ASA 1, while 14 patients (11.1%) were classified as ASA 2 (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur statistical analysis revealed no significant relationships or differences in terms of age, weight, gender, and ASA classification across the different drug groups (p \u0026gt; 0.05)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Demographic characteristics according to drug groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"680\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eK (n=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePK (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDK (n=45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, Mean \u0026plusmn;SD(M)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 136px;\"\u003e\n \u003cp\u003e5,54\u0026plusmn;1,94(5,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e5,77\u0026plusmn;1,82(5,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 119px;\"\u003e\n \u003cp\u003e6,22\u0026plusmn;2,18(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e2,188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0,335\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight(kg), Mean \u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 136px;\"\u003e\n \u003cp\u003e19,53\u0026plusmn;7,48(17,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e21,1\u0026plusmn;8,68(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 119px;\"\u003e\n \u003cp\u003e21,64\u0026plusmn;8,56(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1,182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0,554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eGirl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e19(47,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e22(53,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e21(46,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0,488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0,784\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eBoy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e21(52,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e19(46,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e24(53,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e38(95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e36(87,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e38(84,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2,482\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0,297\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e2(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e5(12,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7(15,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt;0,05 and \u0026dagger;Fisher\u0026rsquo;s Exact test, ASA (American Society of Anesthesiologists Classification), K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine)\u003c/p\u003e\n\u003cp\u003eRegarding the types of procedures performed, patients in the K group underwent 150 fillings, 9 root canal treatments, and 65 extractions. In the PK group, 216 fillings, 28 root canals, 68 extractions, and 3 amputations were performed. The DK group received 258 fillings, 44 root canal treatments, 73 extractions, and 6 amputations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eKetamine addition\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant correlation was found between the necessity for additional doses of ketamine and the drug groups (p \u0026lt; 0.05). Within the K group, the majority of cases required 3 to 4 additional doses. For the PK group, the additional dose requirement predominantly ranged between 2 to 4 times, while 26 patients (57.8%) did not need any extra dose, and the requirement was limited to\u003cins cite=\"mailto:ÖZNUR%20ÖZALP\" datetime=\"2024-03-20T10:41\"\u003e\u0026nbsp;\u003c/ins\u003eone additional dose for the remaining in the DK group. The average number of additional doses was calculated as 3.40\u0026plusmn;1.32 for the K group, 2.44\u0026plusmn;1.38 for the PK group, and 0.46\u0026plusmn;0.62 for the DK group (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Drug groups with the requirement for additional doses of Ketamine\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eK (n=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePK(n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDK (n=45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTest Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdditional Dose, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4(9,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e26(57,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e91,575\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3(7,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7(17,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e18(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e8(19,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13(31,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e12(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e8(19,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3(7,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3(7,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdditional Dose, Mean.\u0026plusmn;SD (M)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3,40\u0026plusmn;1,32(3,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2,44\u0026plusmn;1,38(3,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e00,46\u0026plusmn;0,62(0,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69,857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt;0,05 and \u0026dagger;Fisher\u0026rsquo;s Exact test\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNasal O2 support\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant association was observed between the requirement for nasal O2 support and the different drug groups (p \u0026lt; 0.05). In the K and DK groups, there was generally no need for nasal O2 support. In contrast, the PK group predominantly required nasal O2 support at flow rates of 3 and 4 l/min (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eJaw thrust and head tilt/chin lift maneuvers\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFurthermore, a statistically significant relationship was found between the implementation of Jaw Thrust (JT) and Head Tilt/Chin Lift (HT/CL) maneuvers and the drug groups (p \u0026lt; 0.05). While these maneuvers were mostly not necessary in the K and DK groups, their frequency of application was notably higher in the PK group (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAirway suction event (ASE)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant correlation was identified between the need for ASE and the various drug groups (p \u0026lt; 0.05). The requirement for ASE was lower in the PK and DK groups compared to the K group, with the DK group exhibiting the least need for this intervention (Table 3).\u003c/p\u003e\n\u003cp\u003eAdditionally, our analysis revealed no statistically significant relationships or differences in terms of mask ventilation support and endotracheal intubation across the different drug groups (p \u0026gt; 0.05).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Maneuvers according to drug groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eK (n=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePK (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDK (n=45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTest Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNasal O2, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e33(82,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e41(91,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65,523\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5(12,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6(14,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13(31,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13(31,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2(4,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHT/ CL, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e39(97,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e31(75,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e45(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16,453\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10(24,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eJT, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e30(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e25(61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e45(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20,632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16(39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMV, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40(97,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e45(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1,885\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,642\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eASE\u003c/strong\u003e\u003cstrong\u003e, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e14(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e23(56,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e41(91,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29,141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e26(65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e18(43,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4(8,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eETI, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e39(97,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e41(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e45(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1,935\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,326\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt;0,05 and \u0026dagger;Fisher\u0026rsquo;s Exact test, K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine), HT/CL(Head Tilt/Chin Lift), JT(Jaw Thrust), MV(Mask Ventilation), ASE(Airway suction event), ETI(Endotracheal Intubation)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCardio-respiratory changes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStatistically significant differences were observed among the drug groups in terms of apnea, hypoxia, hypotension, hypertension, bradycardia, tachycardia, and postoperative nausea and vomiting (PONV) (p \u0026lt; 0.05) (Table 4).\u003c/p\u003e\n\u003cp\u003eApnea was noted in 7 patients (17.1%) in the PK group, but it was not observed in the K and DK groups. Hypoxia was primarily absent in the K and DK groups, while a higher incidence was recorded in the PK group (Table 4).\u003c/p\u003e\n\u003cp\u003eHypotension was most frequently (20%) identified in the DK group. Bradycardia occurred in 14 patients (31.1%) in the DK group but was not present in the K and PK groups (Table 4).\u003c/p\u003e\n\u003cp\u003eHypertension was observed in 6 patients (15%) in the K group, but not in the PK and DK groups. Tachycardia and PONV were predominantly observed in the K group (Table 4).\u003c/p\u003e\n\u003cp\u003eNo statistically significant correlation was found in terms of bronchospasm across the drug groups (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Complications according to drug groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"644\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eK (n=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePK (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDK (n=45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTest Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eApnea, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34(82,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e45(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12,308\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7(17,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypoxia, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e33(82,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10(24,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e41(91,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49,588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7(17,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e31(75,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4(8,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypotension, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e38(92,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e36(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10,116\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,004*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3(7,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34(85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e41(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e45(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10,452\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBradycardia, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e41(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e31(68,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26,435\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e14(31,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTachycardia, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e24(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40(97,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e44(97,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31,647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBronchospasm, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e38(95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40(97,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e45(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2,155\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,207\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePONV, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e20(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40(97,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e44(97,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43,058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e20(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1(2,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt;0,05 and \u0026dagger;Fisher\u0026rsquo;s Exact test, K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine), PONV(Postoperative Nausea and Vomiting)\u003c/p\u003e\n\u003cp\u003eAn analysis of the changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) over time across the drug groups revealed a general decreasing trend, with the exception of the K group. In the K group, the preoperative values (SBP: 100.07\u0026plusmn;12.12, DBP: 60.82\u0026plusmn;19.86) were slightly lower than those observed at the 5-minute mark (SBP: 103.03\u0026plusmn;12.29, DBP: 62.78\u0026plusmn;9.93), though this difference was not statistically significant. Following the 5th minute, a downward trend similar to the other groups was observed. The DK group exhibited the most pronounced decrease in both SBP and DBP values (Fig. 1).\u003c/p\u003e\n\u003cp\u003eRegarding the mean beats per minute (BPM) values over time, a decreasing trend was observed in all drug groups except for the K group. In the K group, the preoperative BPM mean (104.2\u0026plusmn;12.16) was slightly lower than the value at the 5th minute (110.53\u0026plusmn;10.39); however, this difference was not statistically significant. After the 5th minute, a downward trend was noted, aligning with the trends observed in the other groups. The DK group exhibited the most substantial decrease, particularly between the 5th minute mean (102.8\u0026plusmn;9.71) and the 10th minute mean (90.98\u0026plusmn;9.28), (Fig. 2).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRamsay Sedation Score\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStatistically significant differences were observed between the Ramsay Sedation Score (RSS) and the different drug groups (p \u0026lt; 0.05). In the K and PK groups, the sedation score predominantly ranged between 4 and 5 points. In contrast, the DK group most frequently achieved a sedation score of 6 points (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Ramsay Sedation Score according to drug groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eK (n=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePK (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDK (n=45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRSS, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e15(37,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18px;\"\u003e\n \u003cp\u003e11(26,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e67,823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e19(47,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18px;\"\u003e\n \u003cp\u003e27(65,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e8(17,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e6(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3(7,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e37(82,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt;0,05 and K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine), RSS(Ramsay Sedation Score)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDuration of sedation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was observed in the mean sedation times across the drug groups (p \u0026lt; 0.05). Notably, significant differences were found when comparing the K group with both the PK and DK groups, as well as between the PK and DK groups (p = 0.001, p = 0.000, p = 0.019). Although the mean sedation times of the PK and DK groups were similar, they were both statistically significantly longer than that of the K group (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRecovery time\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was observed in the mean recovery times among the drug groups (p \u0026lt; 0.05). Significant differences were evident between the DK group and both the K and PK groups (p = 0.000 for both comparisons). While the mean recovery times for the K and PK groups were similar, they were statistically significantly shorter than the mean recovery time of the DK group (Table 6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003eSedation and recovery times according to drug groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eK (n=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePK (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDK (n=45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTest Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSedation Time, Mean.\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(M)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54,58\u0026plusmn;16,38(54)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70,63\u0026plusmn;19,29(71)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e82,69\u0026plusmn;23,37(83)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20,887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecovery Time, Mean.\u0026plusmn;SD (M)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8,95\u0026plusmn;2,5(9)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9,05\u0026plusmn;2,62(9)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34,71\u0026plusmn;6,94(35)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e446,324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt;0,05 and K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAldrete score\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStatistically significant associations were identified between the Aldrete scores at the 1st and 2nd hours and the drug groups (p \u0026lt; 0.05). In the K and PK groups, the Aldrete scores during the 1st hour predominantly ranged between 9 and 10. In contrast, in the DK group, the scores during the 1st hour were chiefly between 6, 7, and 8. (Table 7).\u003c/p\u003e\n\u003cp\u003eAt the second hour, Aldrete scores were calculated to be 10 points for all patients in the PK group and for 95% of the K group. In the DK group, 17 patients (37.8%) scored 9, while 28 patients (62.2%) scored 10 (Table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7:\u003c/strong\u003e Aldrete scores according to drug groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eK (n=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePK (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDK (n=45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Test Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003csup\u003est\u003c/sup\u003e hour n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e6(13,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e109,701\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e10(22,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2(4,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e25(55,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e18(45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e16(39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e4(8,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e22(55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e23(56,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003csup\u003end\u003c/sup\u003e hour, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e17(37,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e28,559\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e38(95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e41(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e28(62,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt;0,05 and \u0026dagger;Fisher\u0026rsquo;s Exact test, K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDentist satisfaction\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant correlation was established between dentist satisfaction and the drug groups (p \u0026lt; 0.05). Dentist satisfaction was predominantly higher in the DK group, whereas neutral and dissatisfied responses were more frequently observed in the K and PK groups. No statistically significant difference in satisfaction levels was noted between the K and PK groups (Table 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8:\u003c/strong\u003e Dentist satisfaction according to drug groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"103%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eK (n=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePK (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDK (n=45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentist satisfaction, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e11(27,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e14(34,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e4(8,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e33,217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eDissatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e12(30,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e12(29,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0(0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e17(42,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e15(36,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e41(91,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt;0,05 and K(Ketamine), PK(Propofol-Ketamine), DK(Dexmedetomidine-Ketamine)\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eSedation in pediatric patients is increasingly utilized, particularly in dental treatments where airway sharing with the dental team adds procedural complexity. The risk of aspirating fluids or foreign materials further complicates sedation management. Therefore, pediatric dental sedation requires the expertise of an anesthesia team experienced in dental procedures to ensure safety and effectiveness.\u003c/p\u003e\n\u003cp\u003eThis study provides both methodological and clinical value by comparing sedative regimens based on their side-effect profiles and suitability for extended procedures\u0026mdash;an area not widely covered in current literature. Its relevance is particularly notable in pediatric dentistry, where precise airway control is essential and must be managed by skilled anesthesiologists.\u003c/p\u003e\n\u003cp\u003eIn the K group, additional ketamine doses were commonly required, likely due to the absence of continuous infusion. Similarly, the PK group showed a higher need for supplemental dosing compared to the DK group. This may be explained by the deeper and more stable sedation achieved with dexmedetomidine bolus loading in the DK group.\u003c/p\u003e\n\u003cp\u003eEvans et al. reported progressive upper airway narrowing with increasing anesthesia depth during propofol use (15). In line with the literature, apnea and hypoxia\u0026mdash;presumably related to propofol\u0026mdash;were more frequently observed in the PK group in our study (16). Consequently, oxygen support and airway maneuvers were required more often in this group. While dexmedetomidine may also cause respiratory depression at high doses (17-19). such complications were less frequent in our DK group, likely due to appropriate dosing. In our study, the DK group showed a lower incidence of respiratory complications compared to the PK group, likely due to careful dosing that avoided the higher levels associated with respiratory depression. These results highlight the clinical value of dexmedetomidine in settings where respiratory risk is a concern. Kim G. et al. noted that respiratory depression with ketamine is extremely rare unless administered rapidly at high doses (20). Consistent with this, apnea, hypoxia, and related interventions were less frequent in the K group.\u003c/p\u003e\n\u003cp\u003eThe antisecretory effect of dexmedetomidine, previously described in the literature, likely contributed to the lower incidence of increased salivation and ASE in the DK group (17, 21, 22). In contrast, excessive secretion and frequent need for ASEs were most commonly observed in the K group, consistent with ketamine\u0026rsquo;s known secretory effects (23).\u003c/p\u003e\n\u003cp\u003eByron C. et al. highlighted the hypotensive effects of dexmedetomidine (21, 24). In line with this, our study found a higher incidence of hypotension in the DK group, while no such cases were recorded in the K group.\u003c/p\u003e\n\u003cp\u003eDexmedetomidine\u0026rsquo;s bradycardic effect has been well-documented in the literature (21, 24), and our findings align with this, showing a significantly higher incidence of bradycardia in the DK group. Despite the tachycardic properties of atropine and ketamine used in premedication, a gradual heart rate decline was observed following dexmedetomidine bolus administration. In some cases, initial tachycardia induced by ketamine was effectively counteracted by dexmedetomidine, ultimately resulting in bradycardia. Overall, in the DK group, the combined sympatholytic effect of dexmedetomidine appeared to override the transient tachycardic response to premedication.\u003c/p\u003e\n\u003cp\u003eKetamine\u0026rsquo;s hypertensive and tachycardic effects are well-established in the literature (23). In our study, hypertension was most frequently observed in the K group, likely due to the higher cumulative doses of ketamine compared to the PK and DK groups, where propofol and dexmedetomidine\u0026apos;s hypotensive effects may have provided balance. Similarly, tachycardia was common in the K group, which may be attributed not only to ketamine\u0026rsquo;s sympathomimetic properties but also to the use of atropine as an antisecretory premedication. The routine use of atropine\u0026mdash;necessitated by the unavailability of glycopyrrolate in our setting\u0026mdash;may have further contributed to the elevated heart rate.\u003c/p\u003e\n\u003cp\u003ePONV is a well-known adverse effect associated with ketamine administration (23, 25, 26). In our study, the K group exhibited the highest incidence of PONV, which can likely be attributed to the use of repeated high doses of ketamine. In contrast, the lower PONV rates observed in the PK and DK groups may be explained by the established antiemetic properties of propofol and the emerging evidence supporting the antiemetic effects of dexmedetomidine (27-29).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, analysis of RSS demonstrated that the DK group achieved deeper levels of sedation, with significantly higher scores than those observed in the other groups.\u003c/p\u003e\n\u003cp\u003eRecovery times were found to be significantly longer in the DK group.\u0026nbsp;Despite the intraoperative advantages observed with the DK combination, such as hemodynamic stability and reduced respiratory complications, the recovery time was notably longer compared to the other groups. This may be attributed to the pharmacological profile of dexmedetomidine, particularly its longer elimination half-life and sedative persistence (21). From a clinical perspective, future strategies such as adjusting the timing of drug cessation or modifying infusion protocols may help mitigate this delay without compromising intraoperative safety.\u003c/p\u003e\n\u003cp\u003eThe lower Aldrete scores observed in the DK group during the first postoperative hour were consistent with delayed recovery. However, by the second hour, differences among the groups were no longer statistically significant, likely due to the complete clearance of sedatives. These findings suggest that, despite initial delays, outpatient procedures can still be completed safely without requiring hospital admission.\u003c/p\u003e\n\u003cp\u003eDentists reported the highest level of procedural satisfaction in the DK group. This was primarily attributed to enhanced patient immobility and the absence of intraoperative complications requiring anesthetic intervention. Notably, although prolonged recovery is an important consideration for anesthesiologists and caregivers, it did not negatively impact dentist satisfaction. This highlights that intraoperative stability and workflow efficiency may carry greater weight than recovery duration in the assessment of procedural quality by dental practitioners.\u003c/p\u003e\n\u003cp\u003eThe use of sedation in pediatric dentistry continues to expand, offering an alternative to general anesthesia, which\u0026mdash;despite its perceived safety\u0026mdash;carries significant risks such as bronchospasm and laryngospasm during intubation and extubation. These potential complications underscore the importance of selecting appropriate sedative regimens tailored to both the procedure and patient profile, administered under optimal clinical conditions.\u003c/p\u003e\n\u003cp\u003eKetamine has a well-established safety profile in pediatric sedation, with predictable pharmacodynamics and manageable adverse effects. In this study, we aimed to highlight the relative benefits of two sedative combinations\u0026mdash;ketamine with propofol and ketamine with dexmedetomidine\u0026mdash;each designed to offset the limitations of ketamine monotherapy. While propofol is known to enhance sedation depth, it poses an increased risk of respiratory depression and blunted protective reflexes, especially in intraoral procedures where the airway is shared. In contrast, dexmedetomidine offers a favorable respiratory safety profile, making it a compelling adjunct. When combined with ketamine, it attenuates ketamine-induced tachycardia, hypertension, and hypersalivation, offering improved intraoperative conditions. Nevertheless, dexmedetomidine\u0026rsquo;s prolonged recovery time presents a notable clinical challenge. This drawback, however, can be partially addressed by timing the discontinuation of infusion in coordination with the pedodontic team. Additionally, although its cost may limit routine use, the overall economic impact must be weighed against the potential for complications, increased interventions, and delayed discharges associated with alternative agents.\u003c/p\u003e\n\u003cp\u003eThis study has several limitations that should be acknowledged. First, its retrospective design limited the ability to control variables such as drug cessation timing and patient selection. Second, objective monitoring tools such as bispectral index (BIS) and capnography were not utilized, which may have restricted the accuracy of sedation depth and respiratory status assessments. Additionally, outcome assessment was not blinded, which may have introduced observer bias. Another potential limitation is the involvement of multiple operators with varying levels of clinical experience. Although cases were evenly distributed between faculty members and senior residents, individual differences in technique and behavior management may have influenced sedation quality and procedural outcomes. Future prospective studies incorporating standardized sedation protocols, objective monitoring tools, and blinded assessments are warranted to validate and expand upon these findings.\u003c/p\u003e\n\u003cp\u003eBased on our findings, specific recommendations can be made regarding the selection of sedation regimens tailored to procedural requirements and patient characteristics:\u003c/p\u003e\n\u003cp\u003e\u0026ndash; Ketamine monotherapy may be appropriate for short-duration procedures (\u0026lt;45 minutes) in healthy, cooperative patients (ASA I), where rapid recovery and cost-effectiveness are prioritized.\u003c/p\u003e\n\u003cp\u003e\u0026ndash; Propofol\u0026ndash;Ketamine combination (PK) appears preferable for moderate-duration procedures (45\u0026ndash;60 minutes) that require a deeper level of sedation, provided that close monitoring for respiratory depression is available.\u003c/p\u003e\n\u003cp\u003e\u0026ndash; Dexmedetomidine-Ketamine combination (DK) is best suited for long-duration procedures (\u0026gt;60 minutes) or those involving shared airway challenges, particularly in patients with increased secretion, elevated aspiration risk, or hemodynamic sensitivity.\u003c/p\u003e\n\u003cp\u003eTailoring sedation strategies to procedural complexity and individual patient profiles is essential for maximizing both safety and clinical efficiency in pediatric dental settings.\u003c/p\u003e\n\u003cp\u003eIn conclusion, this retrospective study offers valuable comparative insights into three sedation approaches\u0026mdash;ketamine alone, ketamine with propofol, and ketamine with dexmedetomidine\u0026mdash;for pediatric dental procedures requiring extended sedation. Among these, the dexmedetomidine-ketamine combination (DK group) provided superior intraoperative stability, fewer respiratory complications, and a lower incidence of airway secretions, thereby enhancing procedural conditions and dentist satisfaction. However, its association with prolonged recovery underscores the need for careful perioperative coordination. Despite certain limitations, including its retrospective design, this study addresses a critical gap in the literature by evaluating sedation practices in pediatric dental procedures involving complex airway management. These findings may assist clinicians in optimizing sedation protocols and selecting appropriate drug combinations to enhance procedural success and patient safety.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASA: American Society of Anesthesiologists\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRSS: Ramsay Sedation Score\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHT/CL: Head Tilt/Chin Lift\u003c/p\u003e\n\u003cp\u003eJT: Jaw Thrust\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMV: Mask Ventilation\u003c/p\u003e\n\u003cp\u003eASE: Airway Suction Event\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eETI: Endotracheal Intubation\u003c/p\u003e\n\u003cp\u003ePONV: Postoperative Nausea and Vomiting\u003c/p\u003e\n\u003cp\u003eSBP: Systolic Blood Pressure and\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDBP: Diastolic Blood Pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBPM: Beats Per Minute\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBIS: Bispectral Index\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical Research Ethics Committee of the Akdeniz University, Antalya, Turkiye approved the study (Approval Number: KAEK-251). All patients were informed about the content and the aim of the study and verbal and written informed consents were obtained from the patients and, when applicable, their families or legal guardians, in accordance with ethical guidelines for clinical data acquisition.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable. (In accordance with the guidelines set forth by the International Committee of Medical Journal Editors (ICMJE), this retrospective study, which involved the collection of data from patient files and anesthesia records, does not require the assignment of a number from the Clinical Trials (NCT) registry.)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article. Data supporting this research article are available from the corresponding authors on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eF. Oluş designed the study. H. Babun acquired and analyzed the data. F. Oluş and H. Babun performed the sedations. F. Oluş and H. Babun drafted and edited manuscript. All authors have read and agreed to the published version of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWilliams MR, Nayshtut M, Hoefnagel A, McKeown A, Carlson DW, Cravero J, et al. Efficacy outcome measures for pediatric procedural sedation clinical trials: an ACTTION systematic review. Anesthesia \u0026amp; Analgesia. 2018;126(3):956-67.\u003c/li\u003e\n\u003cli\u003eASA. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004-17.\u003c/li\u003e\n\u003cli\u003eCote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatric dentistry. 2016;38(4):13E-39E.\u003c/li\u003e\n\u003cli\u003eStern J, Pozun A. Pediatric procedural sedation. 2021.\u003c/li\u003e\n\u003cli\u003eCoté CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics. 2000;106(4):633-44.\u003c/li\u003e\n\u003cli\u003eAlletag MJ, Auerbach MA, Baum CR. Ketamine, Propofol, and Ketofol Use for Pediatric Sedation. Pediatric Emergency Care. 2012;28(12):1391-5.\u003c/li\u003e\n\u003cli\u003eShaaban AR, Kamal S, Okasha MM. Comparison of dexmedetomidine versus propofol for maintenance of anesthesia during invasive procedures in pediatric oncology patients: a controlled randomized double-blind study. Ain Shams Journal of Anesthesiology. 2014;7(2).\u003c/li\u003e\n\u003cli\u003eJoshi AB, Shankaranarayan UR, Hegde A, Manju R. To Compare the efficacy of two intravenous combinations of drugs ketamine\u0026ndash;propofol vs ketamine\u0026ndash;dexmedetomidine for sedation in children undergoing dental treatment. International Journal of Clinical Pediatric Dentistry. 2020;13(5):529.\u003c/li\u003e\n\u003cli\u003eNelson Laura E, Lu J, Guo T, Saper Clifford B, Franks Nicholas P, Maze M. The \u0026alpha;2-Adrenoceptor Agonist Dexmedetomidine Converges on an Endogenous Sleep-promoting Pathway to Exert Its Sedative Effects. Anesthesiology. 2003;98(2):428-36.\u003c/li\u003e\n\u003cli\u003eDoze VA, Chen BX, Maze M. Dexmedetomidine produces a hypnotic-anesthetic action in rats via activation of central alpha-2 adrenoceptors. Anesthesiology. 1989;71(1):75-9.\u003c/li\u003e\n\u003cli\u003eHsu Y-W, Cortinez Luis I, Robertson Kerri M, Keifer John C, Sum-Ping Sam T, Moretti Eugene W, et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology. 2004;101(5):1066-76.\u003c/li\u003e\n\u003cli\u003eCuschieri S. The STROBE guidelines. Saudi journal of anaesthesia. 2019;13(Suppl 1):S31-S4.\u003c/li\u003e\n\u003cli\u003eCohen J. Statistical power analysis for the behavioral sciences: Academic press; 2013.\u003c/li\u003e\n\u003cli\u003eHeard C, Burrows F, Johnson K, Joshi P, Houck J, Lerman J. A Comparison of Dexmedetomidine-Midazolam with Propofol for Maintenance of Anesthesia in Children Undergoing Magnetic Resonance Imaging. Anesthesia \u0026amp; Analgesia. 2008;107(6):1832-9.\u003c/li\u003e\n\u003cli\u003eEvans Russell G, Crawford Mark W, Noseworthy Michael D, Yoo S-J. Effect of Increasing Depth of Propofol Anesthesia on Upper Airway Configuration in Children. Anesthesiology. 2003;99(3):596-602.\u003c/li\u003e\n\u003cli\u003eAun C. New iv agents. British journal of anaesthesia. 1999;83(1):29-41.\u003c/li\u003e\n\u003cli\u003eBelleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77(6):1125-33.\u003c/li\u003e\n\u003cli\u003eBhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59(2):263-8.\u003c/li\u003e\n\u003cli\u003eHall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, Amnestic, and Analgesic Properties of Small-Dose Dexmedetomidine Infusions. Anesthesia \u0026amp; Analgesia. 2000;90(3):699-705.\u003c/li\u003e\n\u003cli\u003eKim G, Green SM, Denmark TK, Krauss B. Ventilatory Response during Dissociative Sedation in Children\u0026mdash;A Pilot Study. Academic Emergency Medicine. 2003;10(2):140-5.\u003c/li\u003e\n\u003cli\u003eVenn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54(12):1136-42.\u003c/li\u003e\n\u003cli\u003eNaaz S, Ozair E. Dexmedetomidine in current anaesthesia practice- a review. J Clin Diagn Res. 2014;8(10):Ge01-4.\u003c/li\u003e\n\u003cli\u003eSinner B, Graf BM. Ketamine. In: Sch\u0026uuml;ttler J, Schwilden H, editors. Modern Anesthetics. Berlin, Heidelberg: Springer Berlin Heidelberg; 2008. p. 313-33.\u003c/li\u003e\n\u003cli\u003eBloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology. 1992;77(6):1134-42.\u003c/li\u003e\n\u003cli\u003eTsze DS, Steele DW, Machan JT, Akhlaghi F, Linakis JG. Intranasal Ketamine for Procedural Sedation in Pediatric Laceration Repair: A Preliminary Report. Pediatric Emergency Care. 2012;28(8):767-70.\u003c/li\u003e\n\u003cli\u003eFallahinejad Ghajari M, Ansari G, Soleymani AA, Shayeghi S, Fotuhi Ardakani F. Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3-6-year-old Uncooperative Dental Patients. J Dent Res Dent Clin Dent Prospects. 2015;9(2):61-5.\u003c/li\u003e\n\u003cli\u003eOkawa H, Ono T, Hashiba E, Tsubo T, Ishihara H, Hirota K. Decreased postoperative nausea and vomiting with dexmedetomidine after off-pump coronary artery bypass grafting. Critical Care. 2011;15(1):P351.\u003c/li\u003e\n\u003cli\u003eKim SY, Kim JM, Lee JH, Song BM, Koo BN. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. BJA: British Journal of Anaesthesia. 2013;111(2):222-8.\u003c/li\u003e\n\u003cli\u003eBorgeat A, Stirnemann HR. [Antiemetic effect of propofol]. Anaesthesist. 1998;47(11):918-24.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sedation, Sedoanalgesia, Pedodontics, Dexmedetomidine, Ketamine, Propofol","lastPublishedDoi":"10.21203/rs.3.rs-5052525/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5052525/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The use of sedation in the field of pediatric dentistry is becoming increasingly prevalent. While general anesthesia is perceived as a safer alternative, the appropriate use of sedatives, in conjunction with a well-trained team, can effectively mitigate the risks associated with sedation. Our study aims to identify safe drug combinations for prolonged sedation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThis study was conducted in the Operating Room of the Faculty of Dentistry at Akdeniz University. It encompassed 126 patients, classified as ASA 1-2, aged between 3 and 12 years, who underwent dental treatment with sedation support in the Department of Pedodontics from May to December 2022. The patients were categorized into three groups: 1) Ketamine, 2) Propofol-Ketamine (PK), and 3) Dexmedetomidine-Ketamine (DK). During the procedures, vital signs, the requirement for additional doses, complications, and interventions were meticulously documented. Additionally, the Ramsay Sedation Score (RSS), dentist satisfaction during the procedure, recovery time, and Aldrete scores for the postoperative 1st and 2nd hours were also recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThere were no statistically significant differences between the groups in terms of age, gender, mean weight, and ASA. The minimum requirement for additional doses was recorded in the DK group. Respiratory depression, apnea, hypoxia, and related maneuvers were most frequently observed in the PK group. DK group had minimum requirement for airway suction event. Hypertension and tachycardia were most frequently observed in the K group, while hypotension and bradycardia were most frequently recorded in the DK group. PONV were most common in the K group in which high ketamine doses were administered. RSS was highest in the DK group. The longest recovery times were observed in the DK group. 1st hour Aldrete scores were lower in the DK group. Dentists reached the highest level of satisfaction in the DK group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e This retrospective study provides comparative insights into three sedation regimens for pediatric dental procedures. The dexmedetomidine-ketamine combination demonstrated superior intraoperative stability and fewer respiratory complications, though recovery was prolonged. These findings may guide clinicians in selecting appropriate sedation strategies to improve safety and procedural outcomes in cases involving shared airway management.\u003c/p\u003e","manuscriptTitle":"Sedation Applications in Pedodontics Procedures: Which One Should We Choose?: A retrospective analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 13:52:06","doi":"10.21203/rs.3.rs-5052525/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-08-28T11:54:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-09T09:17:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210911232292935984416506405859306812056","date":"2025-06-04T00:15:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-03T08:11:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-03T07:46:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-06-02T10:11:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"134b3275-a697-44f1-ae56-8e14006103f9","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:02:19+00:00","versionOfRecord":{"articleIdentity":"rs-5052525","link":"https://doi.org/10.1186/s12903-025-06871-w","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-10-08 15:58:06","publishedOnDateReadable":"October 8th, 2025"},"versionCreatedAt":"2025-07-15 13:52:06","video":"","vorDoi":"10.1186/s12903-025-06871-w","vorDoiUrl":"https://doi.org/10.1186/s12903-025-06871-w","workflowStages":[]},"version":"v1","identity":"rs-5052525","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5052525","identity":"rs-5052525","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}