Propofol-assisted deep extubation in the dental treatment of pediatrics: a randomized controlled triple-blind trial

To verify whether propofol-assisted deep extubation is associated with fewer complications in pediatric patients undergoing dental treatment.

This prospective study enrolled 60 pediatric candidates undergoing elective dental interventions, with randomized allocation to either deep extubation (DE; n = 30) or awake extubation (AE; n = 30) protocols. The primary endpoint was the incidence of at least 1 respiratory adverse event, whereas time to extubation (TOE), time to wake-up (TOW), hemodynamic fluctuations during extubation, incidence of emergence agitation (EA), nasal obstruction, epistaxis, sore throat, and hoarse voice after extubation were the secondary endpoints.

The DE group reported significantly lower incidence of at least 1 respiratory adverse event (0.0% VS 23.3%, P = 0.016). The TOE was significantly shorter in the DE group, averaging 2.78 ± 0.87 min, compared to 5.50 ± 1.01 min in the AE group (P < .001). The TOW was longer in the DE group, with an average of 15.03 ± 3.44 min compared to 10.63 ± 1.52 min in the AE group (P < .001). The average value of mean arterial pressure (AVMAP) during extubation was lower in the DE group at 74.70 ± 13.35 mmHg, compared to 87.43 ± 15.31 mmHg in the AE group (P < .001). The average value of heart rate (AVHR) in the DE group was 108.37 ± 13.41 bpm, while in the AE group, it was 127.93 ± 20.74 bpm (P < .001). Additionally, the rates of sore throat and hoarse voice were significantly lower in the DE group (6.7% and 3.3%) than in the AE group (27% and 30%).

For pediatric patients undergoing dental treatment, propofol-assisted deep extubation is superior, allowing for less extubation time without increasing airway complications. This technique provides a smoother extubation with fewer hemodynamic fluctuations and lower incidences of voice hoarseness and persistent coughing, provided that certain rules for deep extubation are followed.