Article

Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy.

Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey.
Pediatric Anesthesia (Impact Factor: 1.74). 11/2007; 17(10):983-8. DOI: 10.1111/j.1460-9592.2007.02206.x
Source: PubMed

ABSTRACT The aim of this study was to compare the clinical efficacy and safety of propofol-ketamine with propofol-fentanyl in pediatric patients undergoing diagnostic upper gastrointestinal endoscopy (UGIE).
This was a prospective, randomized, double blinded comparison of propofol-ketamine with propofol-fentanyl for sedation in patients undergoing elective UGIE. Ninety ASA I-II, aged 1 to 16-year-old patients were included in the study. Heart rate (HR), systolic arterial pressure, peripheral oxygen saturation, respiratory rate (RR) and Ramsey sedation scores of all patients were recorded perioperatively. Patients were randomly assigned to receive either propofol-ketamine (PK; n = 46) or propofol-fentanyl (PF; n = 44). PK group received 1 mg x kg(-1) ketamine + 1.2 mg x kg(-1) propofol, and PF group received 1 microg x kg(-1) fentanyl + 1.2 mg x kg(-1) propofol for sedation induction. Additional propofol (0.5-1 mg x kg(-1)) was administered when a patient showed discomfort in either group.
The number of patients who needed additional propofol in the first minute after sedation induction was eight in Group PK (17%), and 22 in Group PF (50%) (P < 0.01) and those who did not need additional propofol throughout the endoscopy were 14 in Group PK (30%) and three in Group PF (7%) (P < 0.01). HR and RR values after induction in Group PF were significantly lower than Group PK (P < 0.01).
Both PK and PF combinations provided effective sedation in pediatric patients undergoing UGIE, but the PK combination resulted in stable hemodynamics and deeper sedation though more side effects.

2 Bookmarks
 · 
392 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Puerperal sterilization requires a rapid recovery of the mother so that she can take care of her child. Propofol with fentanyl (PF) is an option, but is associated with intraoperative hypotension, respiratory depression and an unsatisfactory postoperative recovery profile. Propofol with ketamine (PK) appears to be an alternative in terms of haemodynamic stability and analgesia. Materials and Methods: This randomized clinical trial involved 60 patients who were scheduled to undergo puerperal sterilization, who belonged to American society of anaesthesiologists (ASA) physical status 1. Patients were randomly allocated to receive either ketamine - propofol infusion in a concentration of 8mg/ml each (group PK) or fentanyl 2μg/kg intravenously, followed by an infusion of propofol in a concentration of 8mg/ml (group PF). In both the groups, the infusion was started at 300ml/hr till patient lost consciousness. Subsequently, the rate was set at 1.5ml/kg/hr for group PF and at 0.75ml/kg/hr for group PK. After the initial 10 minutes, the infusion rate was reduced to 1ml/kg/hr for group PF and to 0.5ml/kg/hr for group PK. Blood pressure and saturation were the primary outcomes which were measured. Results: Patients from group PF recorded a significant drop in the systolic blood pressure from the 5(th) minute, in diastolic pressure from the 10(th) minute and transient oxygen desaturation, as compared to group PK. Patients in group PK had adequate surgical conditions and better recovery profiles in terms of pain and sedation. Conclusion: The combination of ketamine and propofol is a safe and possibly superior alternative to propofol - fentanyl combination in patients who undergo puerperal sterilization, in terms of haemodynamic stability and respiratory depression.
    Journal of clinical and diagnostic research : JCDR. 05/2014; 8(5):GC01-4.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Pain after surgery is one of the major problems in patients with intertrochanteric fracture. This study investigates administration of single-dose Methylprednisolone prior to surgery with the goal of reducing Post-operative pain. Materials and Methods: The study was a Double Blind Randomized Clinical Trial. Eighty two patients with stable intertrochanteric unilateral fracture were selected and divided into two groups: one received Methylprednisolone (MP) 125 mg and the other received placebo. Pain was evaluated at rest and 45° flexion of the hip in times 4, 6, 8, 12, 24, 36, and 48 hours and during walking in times 24, 36, and 48 hours after the surgery. Post-operative nausea, vomiting and fatigue and changes in C - reactive protein (CRP) levels before and after the surgery were also recorded. Results: Pain at rest, 45° flexion of the hip and during walking after the surgery was significantly lower in the MP group compared to the control group (p < 0.001). Fatigue (p = 0.002) and changes in CRP (p=0.001) were significantly lower in MP group. Incidence of nausea, vomiting (p = 0.37) and opioid consumption (p = 0.49) were not significantly different between the two groups. Conclusion: Single-dose methylprednisolone 125 mg (IV) can reduce Post-operative pain in patients with intertrochanteric fracture undergoing elective surgery.
    Journal of Clinical and Diagnostic Research 01/2014;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: This study aims to evaluate the efficacy of topical lidocaine as an adjuvant drug to sedatives in children and adolescents undergoing digestive endoscopies. METHODS: 80 patients (49 females and 31 males, 12±3 years old) were randomly allocated into placebo (n=40) or lidocaine group (n=40). One patient was excluded from each group after allocation. Two puffs of either 10% lidocaine or placebo (tannic acid 0.5%) were sprayed into the oropharynx before the infusion of propofol. Patients were monitored during the procedure and answered a questionnaire after the procedure to evaluate sore throat and the medicine used as pre-medication. The primary outcome measure was propofol dose. Time spent in the procedure room, in the procedure and the incidence of complications were secondary outcome measures. RESULTS: Demographic data (age, sex and endoscopy indication) were evenly distributed in each group. The dose of propofol was not different between patients and controls (placebo group 3.1±1.1 and lidocaine group 2.9±1.3mg/kg; p=0.69), even considering the total dose (p=0.33). The time spent in the procedure room was longer for the placebo group than for the lidocaine group (23±7 versus 20±5 minutes; 95%CI of the difference: 0.47-5.89 minutes, p=0.02). There was no difference between groups regarding procedure duration, complications incidence and tolerability. CONCLUSIONS: Topic anesthetic medication reduces the time spent in the procedure room without increasing the incidence of side effects (NCT00521703).
    Revista Paulista de Pediatria 12/2009; 27(4):424-429.

Full-text

Download
140 Downloads
Available from
May 26, 2014