Addition of ketamine to propofol for initiation of procedural anesthesia in children reduces propofol consumption and preserves hemodynamic stability.
BACKGROUND
There is no ideal anesthesia protocol to perform short invasive procedures in pediatric oncology. The combination of propofol and ketamine may offer advantages over propofol alone.


METHODS
In a prospective, randomized, double-blind study, we analyzed 63 consecutive procedures performed in 47 oncology children. All patients received 1 mug/kg fentanyl, followed by propofol 1 mg/kg in group P (n=33) or propofol 0.5 mg/kg and ketamine 0.5 mg/kg in group PK (n=30) for the initiation of anesthesia. The need for supplementation with propofol and/or fentanyl to maintain an adequate level of anesthesia was recorded. The hemodynamic and respiratory profile, recovery time and the occurrence of side effects were compared.


RESULTS
Significantly more children required propofol (100% vs. 83.3%) and fentanyl (75.5% vs. 43.3%) rescue doses, and developed hypotension (63.6% vs. 23.4%) and bradycardia (48.5 vs. 23.4%) in group P compared with group PK, with a comparable incidence of respiratory adverse events and recovery times. However, 40% of children in group PK were agitated following recovery compared with 6% in group P.


CONCLUSIONS
The combination of propofol and ketamine for invasive procedures in pediatric oncology resulted in reduced propofol and fentanyl consumption and preserved hemodynamic stability, but more children in the combination group recovered with agitation.
Aouad
M T
MT
Department of Anesthesiology, American University of Beirut, Medical Center, Beirut, Lebanon.
Moussa
A R
AR
Dagher
C M
CM
Muwakkit
S A
SA
Jabbour-Khoury
S I
SI
Zbeidy
R A
RA
Abboud
M R
MR
Kanazi
G E
GE
D000293:Adolescent; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D001707:Biopsy, Needle; D001794:Blood Pressure / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D015742:Propofol / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011595:Psychomotor Agitation; D012119:Respiration / Q000187:drug effects; D013129:Spinal Puncture; D013997:Time Factors
D000700:Analgesics; D018686:Anesthetics, Intravenous; D007649:Ketamine; D005283:Fentanyl; D015742:Propofol