Propofol and Propofol–Ketamine in Pediatric Patients Undergoing Cardiac Catheterization
ABSTRACT We investigated the effects of propofol and propofol-ketamine on hemodynamics, sedation level, and recovery period in pediatric patients undergoing cardiac catheterization. We performed a prospective, randomized, double-blind study. The study included 60 American Society of Anesthesiologists physical status II or III (age range, 1 month-13 years) undergoing cardiac catheterization for evaluation of congenital heart disease. Propofol and ketamine were prepared in 5% glucose solution to a final concentration of 5 and 1 mg/ml, respectively; similar injectors containing 5% glucose solution only were prepared. Fentanyl (1 microg/kg) and propofol (1.5 mg/kg) were given to both groups. Then, group 1 received 0.5 ml/kg of 5% glucose and group 2 0.5 ml/kg of ketamine solution by an anesthesiologist who was unaware of the groups of patients. Local anesthesia with 1% lidocaine was administered before intervention in all patients. The noninvasively measured mean arterial pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded at the baseline, following drug administration, at 3, 5, 10, 15, 20, and 30 minutes and then at 15-minute intervals until the end of the procedure. Additional drug and fentanyl requirements to maintain a sedation level of 4 or 5 were recorded. After the procedure, the time to a Steward recovery score of 6 and adverse effects in the first 24 hours were recorded. The number of patients with more than a 20% decrease in mean arterial pressure was 11 in group 1 and 3 in group 2 (p < 0.05). The number of patients who experienced more than a 20% decrease in heart rate was 12 in group 1 and 5 in group 2 (p = 0.054). Ten patients in group 1 and 3 patients in group 2 required additional fentanyl doses (p = 0.057). The number of additional propofol doses was lower in group 2 (p < 0.05). Propofol combined with low-dose ketamine preserves mean arterial pressure better without affecting the recovery and thus is a good option in pediatric patients undergoing cardiac catheterization.
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- "The complementary effects of this combination are supposed to produce lower toxicity compared to each drug alone through decreasing required doses . Ketofol; mixed ketamine and propofol has been shown to be effective in emergency room for procedural sedation         and for induction for rapid sequence intubation. Both drugs; propofol and ketamine were used separately successfully to control emergence agitation in adults and children . "
ABSTRACT: Objective To assess the efficacy and safety of ketofol administration in controlling emergence agitation (EA) after sevoflurane-based anesthesia in children undergoing adenoidectomy or adenotonsillectomy. Subjects and methods This double-blinded randomized study involved 90 children (3–6 years) scheduled for elective adenotonsillectomy or adenoidectomy. They were randomly assigned to receive 10 ml of normal saline (control group, C) or, 1 mg/kg propofol in 10 ml saline (group P) or ketofol as 1 mg/kg propofol and 0.25 mg/kg ketamine in 10 ml saline (group K) 10 min before the end of surgery. In PACU, sedation, behavior, pain and severity of EA were assessed using modified Aldrete score, Aono’s scale, Objective Pain Score (OPS) and Pediatric Anesthesia Emergence Delirium (PAED) scale, respectively. Results In ketofol group, OPS was significantly lower compared to propofol and control groups. Recovery criteria were in favor of ketofol and propofol groups including longer time to eye opening (p < 0.001) and time to Aldrete score ⩾ 9 (p = 0.001). Time to discharge from PACU was comparable in the three groups (p = 0.079). EA was significantly more frequent in the control group (p < 0.001), but comparable in ketofol and propofol groups. PAED score was significantly higher in control group compared to ketofol and propofol groups. Ketofol and propofol preserved hemodynamic stability. Conclusion Ketofol provides a promising new option for controlling emergence agitation with adequate postoperative sedative and analgesic effect, good recovery criteria and hemodynamic stability compared to propofol and control groups in children undergoing adenoidectomy or adenotonsillectomy.Egyptian Journal of Anaesthesia 01/2013; 30(1). DOI:10.1016/j.egja.2013.09.003
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- "Ketofol provided hemodynamic stability or minor changes that were manifested as minimal number of patients showed deviations from their baseline measures and maintenance of ICP after closure of dura and skin closure within the normal range without intraoperative episodes of increased ICP. These data coincided with Akin et al.  who found a significant decrease in mean arterial blood pressure in 11 patients (36.6%) with propofol compared to 3 patients (10%) with ketofol during cardiac catheterization in pediatric patients and concluded that the addition of low-dose ketamine to propofol preserved blood pressure without prolonging recovery or increasing the incidence of adverse events. These results could be attributed to the contradictory effect of both ketamine and propofol on autonomic nervous system, ketamine being sympathomimetic while propofol lessens this effect. "
ABSTRACT: Background The study aimed at evaluating the clinical efficiency of a ketofol-based sedation procedure during awake craniotomy for varied surgical indications.World Pumps 10/2010; 26(4):293-297. DOI:10.1016/j.egja.2010.05.005
Conference Paper: Measurement criteria for neural network pruning[Show abstract] [Hide abstract]
ABSTRACT: A new measure based on hidden-output node activation is proposed for measuring the relevance of hidden nodes in a neural network. The concept has been successfully applied for pruning in several classification problems. The experiments indicate that redundant nodes are pruned down resulting in optimal network topologies. The measure has been compared to the one proposed by Kamimura-Nakanishi (see IEICE Trans. Inf. & Syst., vol.E78-D, no.4, p.484-9, 1995) and also used in the context of a modified cost function where an additional penalty function is added to steer the direction of the hidden node's activation in the process of learningTENCON '96. Proceedings. 1996 IEEE TENCON. Digital Signal Processing Applications; 12/1996