Total intravenous anesthesia for children undergoing brief diagnostic or therapeutic procedures.
OBJECTIVE
To compare the quality of anesthesia with propofol, ketamine, or etomidate in children undergoing brief diagnostic or therapeutic procedures.


METHODS
Retrospective study.


METHODS
University hospital.


METHODS
971 pediatric oncology patients undergoing brief diagnostic or therapeutic procedures outside the operating room during a one-year period.


METHODS
Total intravenous anesthesia was administered primarily with ketamine, etomidate, or propofol for oncology-related procedures such as bone marrow aspiration, lumbar puncture, radiologic imaging, and radiation therapy. Quality assurance data were collected for all patients, including anesthetic technique, dosage, and the occurrence of specific adverse events during anesthesia and recovery periods.


RESULTS
There were 279 anesthesia-related occurrences, comprised almost entirely of five specific events: vomiting, hypoxemia (SpO2 less than 94%), tachycardia, agitation, and myoclonus. Ketamine was associated with vomiting (14.6%), agitation (15.0%), and tachycardia (19.5%). Etomidate was also associated with vomiting (9.9%) and agitation (1.2%). Hypoxemia was rare except in the propofol group (15.7%) and was easily managed with supplemental oxygen, but occasionally required manually assisted ventilation via face mask. In patients receiving propofol vomiting (0.5%) and agitation (1.2%) were rare.


CONCLUSIONS
Anesthesia with propofol, ketamine, or etomidate is safe and efficacious for children undergoing brief procedures. Propofol is associated with a decreased incidence of postanesthetic agitation and vomiting. Its association with respiratory depression is confirmed.
McDowall
R H
RH
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Scher
C S
CS
Barst
S M
SM
D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005045:Etomidate / Q000009:adverse effects; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced; D007223:Infant; D007649:Ketamine / Q000009:adverse effects; D008297:Male; D009207:Myoclonus / Q000139:chemically induced; D015742:Propofol / Q000009:adverse effects; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013610:Tachycardia / Q000139:chemically induced; D014839:Vomiting / Q000139:chemically induced
D007649:Ketamine; D015742:Propofol; D005045:Etomidate