Propofol-Based Procedural Sedation with or without Low-Dose Ketamine in Children
Sheikh Sohail Ahmed1, Mara Nitu1, Shawn Hicks1
1Department of Pediatric Critical Care, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, United States.
Journal of Pediatric Intensive Care
|May 22, 2019
Summary
Adding ketamine to propofol sedation in children significantly reduced recovery time. Both propofol-only and ketamine plus propofol approaches were equally effective and safe for pediatric deep sedation procedures.
Area of Science:
- Pediatric Anesthesiology
- Procedural Sedation
- Pharmacology
Background:
- Propofol is widely used for pediatric deep sedation.
- Its use as a nonanalgesic agent for procedures is debated.
- Two sedation protocols are employed: propofol-only (P-O) and ketamine plus propofol (K+P).
Purpose of the Study:
- To compare the dosing, efficacy, and safety of P-O versus K+P for deep sedation in children.
- To evaluate the impact of ketamine addition on sedation parameters.
Main Methods:
- Retrospective evaluation of 754 pediatric patients undergoing procedural sedation.
- Patients received either P-O or K+P sedation.
- Data collected included sedation doses, procedure time, and recovery time.
Main Results:
- No significant difference in age or weight between the 372 P-O and 382 K+P patients.
- A combined hypoxia incidence of 16% was observed.
- K+P group had longer procedure times (18.7 vs 15.1 min) but shorter recovery times (17.0 vs 22.2 min) compared to P-O.
- Mean propofol dose was lower in the K+P group (0.28 vs 0.40 mg/kg/min).
Conclusions:
- Both P-O and K+P sedation approaches are well-tolerated and effective in pediatric patients.
- Addition of ketamine to propofol is associated with reduced recovery time.
- Decreased propofol requirement in the K+P group likely explains the shorter recovery.
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