A comparison of ketamine + midazolam to propofol for procedural sedation for lumbar puncture in pediatric oncology by nonanesthesiologists—a randomized comparative trial

Abstract

Ketamine-midazolam combination is safer and more effective. Propofol is faster in onset and recovery, and has smoother emergence with poor efficacy at recommended initial doses.

Eutectic mixture of lidocaine and prilocaine versus 1% lidocaine injection for lumbar punctures in pediatric oncology patients

“…Hypotension is likely the result of mild intravascular depletion secondary to prolonged state of fasting in combination with propofol's vasodilatory and myocardial depressant effects . Respiratory adverse events were not prominent in our study as reported in other studies . Propofol reduces airway muscle tone and protective airway reflexes may be reduced or eliminated.…”

“…Our study analysis revealed a significant decrease in the number of adverse events in the EMLA group (19%) as compared with the lidocaine group (41%). The incidence of adverse events reported in previous studies range from 28% to 56% in pediatric oncology patients receiving propofol to 13% to 52% in children receiving propofol with systemic and/or local analgesia for LPs and bone marrow procedures . A decrease in total propofol dose administered to the EMLA group in our study may have resulted in a reduction of the number of adverse events in this group.…”

“…There were fewer adverse events in the recovery period in the EMLA group as compared with the lidocaine group. Propofol use for procedural sedation has been associated with rapid recovery and minimal occurrences of emesis …”

“…The American Academy of Pediatrics (AAP) recommends a combination of analgesic and sedative drugs or general anesthesia for painful procedures in pediatric oncology patients . Propofol is a general anesthetic drug that is administered as a single drug or in combination with systemic or local analgesics for procedural sedation . Fentanyl and alfentanil are the commonly used systemic analgesics, and subcutaneous 1% lidocaine injection or eutectic mixture of lidocaine and prilocaine cream (EMLA cream) application are the commonly used local analgesics for these procedures .…”

A review of the clinical applications of ketamine in pediatric oncology

“…71 For sedation, ketamine is frequently combined with other agents like midazolam, propofol, and dexmedetomidine. 70,[72][73][74] Pellier et al prospectively evaluated a combination of midazolam (IV, 25 mcg/kg) and ketamine (IV, 0.5-2 mg/kg) for procedural sedation in children with cancer, and found it to be safe and effective. 75 Some of the undesirable adverse effects of IV ketamine used for sedation, such as hypersalivation and tachycardia, may be alleviated using atropine.…”