Comparison of propofol-fentanyl with propofol-fentanyl-ketamine combination in pediatric patients undergoing interventional radiology procedures.
BACKGROUND
With an increase in the frequency of interventional radiology procedures in pediatrics, there has been a corresponding increase in demand for procedural sedation to facilitate them. The purpose of our study was to compare the frequency of adverse effects, sedation level, patient recovery characteristics in pediatric patients receiving intravenous propofol fentanyl combination with or without ketamine for interventional radiology procedures. Our main hypothesis was that the addition of ketamine would decrease propofol/fentanyl associated desaturation.


METHODS
Sixty consenting American Society of Anesthesia physical status I-III pediatric patients undergoing interventional radiology procedures under sedation were studied according to a randomized, double-blinded, institutional review board approved protocol. Group 1 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + ketamine 0.5 mg.kg(-1), and group 2 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + same volume of %0.9 NaCl intravenously.


RESULTS
While apnea was not observed in any of the groups, there were three cases (10%) in group 1, and nine cases (30%) in group 2 with oxygen desaturation (P = 0.052). In group 1, 12 (40%) patients and, in group 2, 21 (70%) patients required supplemental propofol during the procedure (P = 0.021). There was no evidence for difference between groups in terms of other side effects except nystagmus.


CONCLUSIONS
In conclusion, addition of low dose ketamine to propofol-fentanyl combination decreased the risk of desaturation and it also decreased the need for supplemental propofol dosage in pediatric patients at interventional radiology procedures.
Erden
I Aydin
IA
Department of Anaesthesiology and Reanimation, Hacettepe University, Sihhiye, Ankara 06100, Turkey. aydinerden@yahoo.com
Pamuk
A Gulsun
AG
Akinci
Seda B
SB
Koseoglu
Ayhan
A
Aypar
Ulku
U
D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D000704:Analysis of Variance; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D015642:Radiology, Interventional / Q000379:methods*; D012119:Respiration / Q000187:drug effects
D000700:Analgesics; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D007649:Ketamine; D010100:Oxygen; D005283:Fentanyl; D015742:Propofol