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: 1.85). 11/2007; 17(10):983-8. DOI: 10.1111/j.1460-9592.2007.02206.x
Source: PubMed


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.

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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 [22]. Ketofol; mixed ketamine and propofol has been shown to be effective in emergency room for procedural sedation [24] [25] [26] [27] [28] [29] [30] [31] and for induction for rapid sequence intubation. Both drugs; propofol and ketamine were used separately successfully to control emergence agitation in adults and children . "
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    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.
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    • "It has always been tried to reduce the adverse effects of propofol regimen by adding other drugs such as sedatives and narcotics (6-9) as much as possible. As the combinations of propofol-midazolam and propofol-fentanyl have never been compared in microlaryngeal surgeries, in this study we aimed to make a comparison between the two combinations regarding effectiveness, vital signs, hemodynamic, and providing a good condition for operation and recovery (10-12) by administering these combinations among the patients referred to Milad Hospital – Tehran during May 2007 and September 2008. "
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