Comparison of propofol versus propofol-ketamine combination for sedation during spinal anesthesia in children: randomized clinical trial of efficacy and safety

• Published in: Pediatric anesthesia Vol. 20; no. 5; pp. 439 - 444
• Main Authors: SINGH, RABINDER, BATRA, YATINDRA K., BHARTI, NEERJA, PANDA, NIDHI B.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2010
• Subjects: Anesthesia Recovery Period; Anesthesia, Spinal - adverse effects; Anesthetics, Dissociative - adverse effects; Blood Pressure - drug effects; Child; Child, Preschool; children; Double-Blind Method; Female; Heart Rate - drug effects; Humans; Hypnotics and Sedatives - adverse effects; ketamine; Ketamine - adverse effects; Male; Oxygen - blood; propofol; Propofol - adverse effects; Prospective Studies; Respiratory Mechanics - drug effects; Safety; sedation; spinal anesthesia; Treatment Outcome
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2010.03286.x

Summary Objectives:  This study was designed to compare the efficacy and safety of propofol vs propofol‐ketamine combination for sedation during pediatric spinal anesthesia. Methods:  Forty children, aged 3–8 undergoing spinal anesthesia for lower abdominal surgeries were included. Participants were randomly assigned into two groups. Group 1 received propofol bolus of 2 mg·kg−1 followed by an infusion of 4 mg·kg−1·h−1. Group 2 received a combination of 1.6 mg·kg−1 propofol and 0.4 mg·kg−1 ketamine followed by an infusion of 3.2 mg·kg−1·h−1 and 0.8 mg·kg−1·h−1, respectively. The infusion rate was titrated to keep the child sedated at University of Michigan Sedation Score of 3. The heart rate, blood pressure, respiratory rate and oxygen saturation were recorded every 5 min. The episodes of spontaneous body movements and requirement of supplemental sedation were recorded. The postoperative recovery was assessed by modified Aldrette score. Results:  Seventeen patients in group 1 and four patients in group 2 (P < 0.001) required extra boluses of study drug to prevent movements during lumbar puncture. Four patients experienced respiratory depression and three airway obstruction in group 1 when compared to one patient each in group 2 (P < 0.05). The recovery time was similar in both groups. None of the patient had postoperative nausea/vomiting or psychomimetic reactions. Conclusions:  Propofol‐ketamine combination provided better quality of sedation with lesser complications than propofol alone and thus can be a good option for sedation during spinal anesthesia in children.