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.

Comparison of ketamine-propofol and remifentanil in terms of hemodynamic variables and patient satisfaction during monitored anaesthesia care

“…However, we think this is clinically insignificant. Akin et al [20,21] showed that propofol administration in combination with low dose ketamine maintains MAP, decreases the risk of respiratory depression, and requires a lower amount of additional doses. This is likely due to the stimulatory effect of ketamine on ventilation by sympathoadrenergic activation [22].…”

The Comparison of Propofol and Ketofol Side Effects During Sedation with Spinal Anesthesia

“…Aldonfatto et al 28 analysed 728 ketofol procedural sedations with a 1:1 ratio and found the combination effective enough in terms of analgesia, recovery times and satisfaction, with few adverse events. Akin et al 29 showed that low-dose ketamine in a cardiac catheterization procedure provided a reduced opioid requirement, with a better haemodynamic profile. Badrinath et al 30 contributed the same idea with their study.…”

Alternative sedation regimens for upper gastrointestinal endoscopy proven to be safe. A retrospective comparative study

“…[22,23-25-28] It has been shown that the addition of ketamine to propofol allowed stable hemodynamics because of sympathomimetic effects of ketamine and reduced risk of hypoxemia even in pediatric patients with cardiac defects during procedural sedations. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]24] In a prospective randomized study by Nejati et al [25] , it was reported that hypotension and hypoxemia was not observed in two of 31 patients (6.45%) and apnea was observed in one of 31 patients (3.2%) during sedation for colonoscopy with a 1:1 mixture of ketamine and propofol. Tosun et al [12] found similar rate of hypoxemia (6.52%) and no hypotension with ketamine and propofol sedation in pediatric patients who underwent UGE.…”

“…[32] Previous studies have revealed that the use of larger initial bolus doses of propofol was associated with higher incidence of hypotension. [22][23][24][25][26][27][28][29][30] Hsieh et al [21] reported hypotension incidence as 23% for an initial bolus of 1 mg/kg propofol, which was then titrated in 10-20 mg increments plus 25 mg of meperidine (dose of propofol, 129.80±37.93 mg). In contrast, Sáenz-López et al [30] reported no hypotension for an initial bolus of 20 mg of propofol, followed by boluses of 10 mg every 30 s plus 25-50 mg of meperidine (dose of propofol, 66.93 mg).…”