Expert: Ronald Levy, M.D. - 10/7/2007

Question
Hello, I had oral surgery on 9/28//07 to remove my two upper wisdom teeth (fully erupted) and was given anesthesia in my IV. I received: Glycopyrrolate .2 mg, Versed 5 mg, Ketamine 30 mg, Propofol 60 mg, Benadryl 50 mg, and 2% Lidocaine epi 1:100x108 mg infiltration. I had a very bad reaction to one of these drugs coming out of the anesthesia, and was rushed to the hospital by ambulance with seizure like body movements. I don't have a  memory of most of that day. This sounds like a lot of medication for a "simple" removal of two teeth, in a 34 year old female in good health with no prior history of reactions to anesthetics. Was this much anesthesia "standard protocol" or do you think he might have overmedicated?

Answer
It depends in part on who was giving the medication. Was it the dentist (who was also performing the procedure) or was it a separate anesthesiologist? The doses themselves are not excessive. To break down the meds:
1) Glycopyrrolate was given to counteract the secretory effects of the Ketamine. The dose was appropriate.
2) Versed was given for sedation and to ameliorate the hallucinogenic or "bad trip" some people get from Ketamine. The dose was not excessive if it was given over time.
3) Propofol was given to put you to sleep for a few minutes (probably while they gave the Lidocaine local anesthesia). Also it has amnesia effects and sedative effects. The dose was OK for that.
4) The Lidocaine was given as a local in the gums. The epi part of that is to reduce the bleeding. This is the only drug I can think that might cause that reaction if it was given intravascularly. This is unlikely and you don't mention if this happened at the end of the procedure or right after they gave the anesthesia.
5) The Ketamine is one of the drugs I don't understand why they gave it unless you were agitated and moving from the Versed and Propofol. Ketamine is similar to phencyclidine (or Special  K on the streets). It is a dissociative anesthetic that is also a pain releiver. The dose was fine.
6) The Benadryl also confuses me. If they gave it as part of the anesthetic it was as a sleep aid but if they gave it when you had the bad reaction, it was given as a treatment for a suspected "allergic" response.

Without knowing more about you, your tolerance to pain, the difficulty in the procedure, I can't say if it was too much or not. The doses are reasonable. The only drugs you might be "allergic" to are the Propofol (Are you allergic to egg whites) and the Lidocaine although any allergy is possible. I would suggest contacting the dentist/anesthesiologist and ask them what their take on it is.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston