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.01/2013; 30(1). DOI:10.1016/j.egja.2013.09.003
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
Conference Paper: Study on surface swelling of SiC by high-dose He-ion implantation[Show abstract] [Hide abstract]
ABSTRACT: Surface modification of hard materials caused by implanting high-concentration He-ions is interesting since it may be applicable to their micro fabrication process. Implantation of He-ions with energies of 140 keV, 570 keV and 1.7 MeV in CVD-polycrystalline β-SiC was carried out at fluences from 1.4×10<sup>20</sup> to 1.9×10 <sup>22</sup> ions/m<sup>2</sup> using a grid mesh to study the possibility of transcription of the grid mesh pattern to SiC. Irradiation temperature was about 300 to 400 K. Masking with a 25 μm grid mesh was used. After irradiation, swelling of the implanted area was estimated by the step-height method using a laser microscope. It was revealed that a mesh pattern was printed on the specimen surface by helium ion irradiation. Relatively large swelling was produced compared with those in other irradiation conditions in the fluence range greater than a few dpa. The height of upheaval pattern depended on the implanted He-ion fluence. Implanted energy dependence of the height was small for these experimental conditions. The transcribed pattern on the SiC surface was stable after annealing up to 1200°C when the implanted fluence was relatively low (1.8×10<sup>21</sup> ions/m<sup>2</sup>)Ion Implantation Technology Proceedings, 1998 International Conference on; 01/2000