Ketamine-propofol versus ketamine-midazolam for procedural sedation and analgesia in children with hematological malignancies: a randomized, open-labeled, cross-over trial

• Published in: Research and Opinion in Anesthesia & Intensive Care Vol. 5; no. 3; pp. 198 - 204
• Main Authors: Adekola, Oyebola, Temiye, Edamisan, Asiyanbi, Gabriel, Akanmu, Nurudeen, Desalu, Ibironke
• Format: Journal Article
• Language: English
• Published: Mumbai Wolters Kluwer India Pvt. Ltd 01.07.2018; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd
• Subjects: Accuracy; Agreements; Analgesia; Anesthesia; Apnea; Blood pressure; Bone marrow; Cancer; Cancer treatment; Chemotherapy; Children; Evidence-based medicine; Hallucinations; Hematology; Hypoxia; Ketamine; Leukemia; Narcotics; Oncology; Pain; Pediatrics; Phenols (Class of compounds); Researchers; Respiration; apnea; hematological malignancies; hypoxia; pain; procedural sedation; ketamine-midazolam; ketamine-propofol
• ISSN: 2356-9115; 2356-9123
• DOI: 10.4103/roaic.roaic_54_17

Background The use of procedural sedation and analgesia for painful procedures in children with hematological malignancies has become a standard practice in recent time. We compared the occurrence of hypoxia, apnea, and pain between ketamine-propofol and ketamine-midazolam combination. Patients and methods This randomized, open-labeled cross-over study was conducted in 60 children aged 1-15 years scheduled for bone marrow aspiration and, or intrathecal chemotherapy. They were divided into two groups of 30 to receive either ketamine-propofol or ketamine-midazolam. Sedation was performed by trained anesthetists according to the study protocol. Data were analyzed with independent t-test, χ2-test and Fisher's exact test. P value 0.05 or less was considered significant. Results A total of 120 procedures were performed. One (1.7%) patient in each group had hypoxia, (P=0.8). The oxygen saturation decreased to 83 and 88% in ketamine-propofol and ketamine-midazolam groups, respectively. This was accompanied by bradycardia with a heart rate of 56 and 58 beats/min, respectively. Both events responded to oxygen therapy. There was no episode of apnea, and all maintained spontaneous respiration. The number of patients with a pain score of at least 5 during the procedure was comparable; ketamine-propofol group [6 (10%)] versus ketamine-midazolam group [4 (6.7%)] (P=0.4). Hallucinations were more common in the ketamine-propofol group [4(6.7%)] than the ketamine-midazolam group [0 (0%)] (P=0.05). Conclusion The occurrence of hypoxia, apnea, and pain was comparable following the administration of ketamine-propofol and ketamine-midazolam combination.