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Total intravenous anesthesia for children undergoing brief diagnostic or therapeutic procedures
R H McDowall1, C S Scher, S M Barst
1Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Study Objective:
To compare the quality of anesthesia with propofol, ketamine, or etomidate in children undergoing brief diagnostic or therapeutic procedures.
Design:
Retrospective study.
Setting:
University hospital.
Patients:
971 pediatric oncology patients undergoing brief diagnostic or therapeutic procedures outside the operating room during a one-year period.
Interventions:
Total intravenous anesthesia was administered primarily with ketamine, etomidate, or propofol for oncology-related procedures such as bone marrow aspiration, lumbar puncture, radiologic imaging, and radiation therapy. Quality assurance data were collected for all patients, including anesthetic technique, dosage, and the occurrence of specific adverse events during anesthesia and recovery periods.
Measurements And Main Results:
There were 279 anesthesia-related occurrences, comprised almost entirely of five specific events: vomiting, hypoxemia (SpO2 less than 94%), tachycardia, agitation, and myoclonus. Ketamine was associated with vomiting (14.6%), agitation (15.0%), and tachycardia (19.5%). Etomidate was also associated with vomiting (9.9%) and agitation (1.2%). Hypoxemia was rare except in the propofol group (15.7%) and was easily managed with supplemental oxygen, but occasionally required manually assisted ventilation via face mask. In patients receiving propofol vomiting (0.5%) and agitation (1.2%) were rare.
Conclusions:
Anesthesia with propofol, ketamine, or etomidate is safe and efficacious for children undergoing brief procedures. Propofol is associated with a decreased incidence of postanesthetic agitation and vomiting. Its association with respiratory depression is confirmed.