Lee KC, Lee BC (2016) Ketofol as a Balanced Anesthetic for Procedural Sedation and Analgesia (PSA) in the Obese Oral Surgery Patient: a Commentary. Int J Dentistry Oral Sci. 03(2), 190-192. 190 OPEN ACCESS http://scidoc.org/IJDOS.php Ketofol as a Balanced Anesthetic for Procedural Sedation and Analgesia (PSA) in the Obese Oral Surgery Patient: a Commentary Research Article Lee KC 1* , Lee BC 2 1 College of Dental Medicine, Columbia University, New York, USA. 2 Resident, Department of Anesthesiology, Columbia University Medical Center, New York, USA. Commentary The goal of moderate “conscious sedation” is to achieve mus- cular relaxation and analgesia while simultaneously maintaining both a purposeful response to verbal commands and spontaneous ventilation without the need for ventilatory support. Although body mass index (BMI) is not necessarily correlated with post- operative complications in dentoalveolar surgery [1], that does not mean that care should not be taken to closely evaluate and monitor the obese patient perioperatively. As a consequence of body habitus, obesity is a condition that may present with a variety of cardiorespiratory comorbidities including but not limited to extrinsic restrictive lung disease, upper airway obstruction, and decreased tolerance to hemodynamic instability [2, 3]. This poses a dilemma for the oral surgeon because some of the most com- monly used agents for procedural sedation and analgesia (PSA) promote pharyngeal collapse, decrease respiratory drive, and de- press hemodynamic parameters. “Ketofol” is a moniker for ketamine and propofol administered either independently or as a single-syringe admixture. Ketofol has been advocated as the ideal PSA combination because the need for lower doses of each agent combined with the opposing actions of both agents theoretically decreases the incidence of dose-related side effects (Table 1). No single PSA agent is ideal for every situation encountered in the management of morbidly obese patients [4]. Therefore, PSA for obese patients should be achieved through balanced sedation. Propofol is a general anes- thetic that acts at the GABA-B receptor to enhance chloride ion channel activity. It is favored in the outpatient setting because of its rapid onset and short duration of action [5]. In sedating doses, propofol produces adequate amnesia and has been shown to have antiemetic properties. The primary disadvantages of propofol are that it depresses both mean arterial blood pressure and res- piratory drive in a dose-dependent manner. In addition, propo- fol’s inability to provide analgesia prevents it from being the sole anesthetic medication for any stimulating procedure. Ketamine is a dissociative anesthetic that is thought to produce its effects primarily through noncompetitive inhibition of the NMDA re- ceptor. Like propofol, it provides amnesia in a dose-dependent manner, but has the added beneits of analgesia and preservation of respiratory and airway relexes. The primary disadvantages of ketamine are that it can induce sympathomimetic reactions, raise intracranial pressures, and worsen nausea/emesis. At higher doses or with rapid infusions, ketamine can paradoxically cause respira- tory depression, but this effect is generally uncommon when used International Journal of Dentistry and Oral Science (IJDOS) ISSN: 2377-8075 *Corresponding Author: Kevin C. Lee, BA, College of Dental Medicine, Columbia University, 622 W 168 th Street, New York, NY 10032, USA. Tel: 3014424571 Email: kcl2136@cumc.columbia.edu Received: January 13, 2016 Accepted: February 09, 2016 Published: February 10, 2016 Citation: Lee KC, Lee BC (2016) Ketofol as a Balanced Anesthetic for Procedural Sedation and Analgesia (PSA) in the Obese Oral Surgery Patient: a Commentary. Int J Dentistry Oral Sci. 03(2), 190-192. Copyright: Lee KC © 2016. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Abstract A hallmark of oral and maxillofacial surgery is the administration of sedation and general anesthesia in the ofice setting. As part of their training, oral surgeons are required to function as anesthesia residents for a minimum of 5 months with commensurate levels of responsibility. The oral surgeon treats a variety of patients and must take increasing care to avoid and manage any untoward anesthetic events. “Ketofol” is a moniker for ketamine and propofol administered either inde- pendently or as a single-syringe admixture. Ketofol is hypothesized to possess the ideal proile for sedation because of the balance provided by both agents. This commentary aims to present the risks and beneits of ketofol and apply this knowl- edge to a patient population who may beneit the most from the combination. Keywords: Ketamine; Propofol; Ketofol; Sedation Dentistry; Dental Anesthesia.