Efficacy of ketamine and midazolam as co-induction agents with propofol for laryngeal mask insertion in children.
OBJECTIVE
Use of midazolam and ketamine lowers the induction dose of propofol (co-induction) producing hemodynamic stability.


BACKGROUND
Large doses of propofol needed for induction and laryngeal mask (LM) insertion in children may be associated with hemodynamic and respiratory effects. Co-induction has the advantage of reducing dose and therefore maintaining hemodynamic stability.


OBJECTIVE
To examine the effect of co-induction on hemodynamics, LM insertion and recovery in children.


METHODS
A prospective, randomized, double-blind, controlled study was conducted in 60 ASA I/II children, age 1-8 years. Normal saline, ketamine 0.5 mg.kg(-1), midazolam 0.05 mg.kg(-1) were administered in groups P (propofol), PK (propofol-ketamine) and PM (propofol-midazolam), respectively, 2 min prior to the administration of the induction dose of propofol. Propofol 3.5 mg.kg(-1) (group P) or 2.5 mg.kg(-1) (groups PK and PM) was used for induction, LM inserted 30 s later and insertion conditions assessed. Heart rate and blood pressure were recorded immediately after propofol bolus, then every min till 2 min after LMA insertion. Recovery was assessed using Steward's Score.


RESULTS
In group P, systolic blood pressure (SBP) showed a significantly greater decrease compared to group PK and group PM (P < 0.005). Only 5% of patients in groups PK and PM showed >20% fall in SBP compared to 89% in group P (P < 0.005). More children in groups PK and PM had acceptable conditions for LM insertion compared to group P (P < 0.05). The time to achieve Steward Score of 6 was longer in groups PK and PM compared to group P (P < 0.005).


CONCLUSIONS
In children, the combination of propofol with ketamine or midazolam produces stable hemodynamics and improved LM insertion conditions but is associated with delayed recovery.
Goel
Shiba
S
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Bhardwaj
Neerja
N
Jain
Kajal
K
D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004357:Drug Synergism; D005260:Female; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D017214:Laryngeal Masks; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D016896:Treatment Outcome
D000700:Analgesics; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D012965:Sodium Chloride; D007649:Ketamine; D008874:Midazolam; D015742:Propofol