Effects of addition of ketamine, fentanyl and saline with Propofol induction on hemodynamics and laryngeal mask airway insertion conditions in oral clonidine premedicated children

Abstract

Background:The aim of this double-blind, prospective, randomized, controlled study was to compare the effect of addition of ketamine; fentanyl and saline with propofol anesthesia on hemodynamic profile and laryngeal mask airway (LMA) insertion conditions in oral clonidine premedicated children.Methods:180 children (age 2 - 10 years) were at first given oral clonidine (4 μg/kg) 90 minutes before operation, and then were randomly allocated to receive either ketamine 0.5 mg/kg (n=60), fentanyl 1 μg/kg (n=60) or 0.9% normal saline (n=60) before induction with propofol 3.0 mg/kg. Insertion of LMA was performed within 1 minute of injection of propofol. Heart rate and mean blood pressure were noted 1 min before induction (baseline), immediately after induction, before and after insertion of LMA for up to 3 min. Following LMA insertion, 6 subjective end points were noted-mouth opening, coughing, swallowing, patient's movement, laryngospasm, and ease of an insertion. LMA insertion summed score was prepared depending upon these variables.Results:LMA insertion summed score was nearly similar in ketamine and fentanyl group, which were significantly better than saline group (P<0.004). Mean blood pressure and heart rate were maintained in ketamine than with fentanyl or saline group. Incidence of prolonged apnea (>120 secs.) was higher in fentanyl group compared to ketamine and saline group.Conclusion:Even in oral clonidine premedicated children, addition of ketamine with propofol provides hemodynamic stability and comparable conditions for LMA insertion like fentanyl propofol with significantly less prolonged apnea.

Evaluation of ketamine versus midazolam as co-induction agents with propofol for laryngeal mask airway insertion in children

“…Similar to our findings, HR decreased significantly at all times when compared to preinduction values in the propofol group. Similar findings were reported by other researches [6,27]. The incidence of injection pain in the present study was significantly lower in PK and PM groups than in propofol group.…”

Laryngeal mask airway placement in children prior to an intravenous line utilizing heart rate as an indicator of anesthetic depth

“…Every patient had their laryngeal mask airway successfully inserted on the first attempt. Our data compare favorably to other studies where ease of laryngeal mask airway placement and airway complications were recorded when the laryngeal mask airway was placed after the IV . In these studies, placement of the laryngeal mask airway Unique or Classic resulted in easy insertion rates of 87.5–98% (98.4% in our study), laryngospasm in 0–5% (0% in our study) and coughing in 0–14% (0% in our study).…”

Effect of Etomidate Versus Combination of Propofol-Ketamine and Thiopental-Ketamine on Hemodynamic Response to Laryngoscopy and Intubation: A Randomized Double Blind Clinical Trial

“…A study by Furuya et al showed that administration of ketamine before induction with propofol preserved hemodynamic stability compared with induction with propofol alone ( 20 ). Another study by Ghatak et al showed that addition of ketamine with propofol provides hemodynamic stability in children premedicated using clonidine for insertion of laryngeal mask airway (LMA) ( 21 ). However, Ozgul et al showed that ketamine-propofol combination provided minimal hemodynamic changes during insertion of laryngeal tube-suction ( 22 ).…”