Ketamine and Propofol Combination Used in Deep Sedation Reduces Opioid Use and Adverse Outcomes in Pediatric Esophagogastroduodenoscopy in Ages 2-18 Years

• Published in: British journal of medical practitioners Vol. 12; no. 3
• Main Authors: Mari, David C, Biswas, Abhik K
• Format: Journal Article
• Language: English
• Published: J M N Medical Education Ltd 01-09-2019
• Subjects: Analysis; Care and treatment; Heart beat; Ketamine; Medical centers; Pain; Pediatrics; Phenols; Propofol
• ISSN: 1757-8515; 1757-8515

Background: Aesophagogastroduodenoscopy (EGD) procedures can elicit significant pain and cause complications in children. Therefore it is essential to use sedation agent(s) that reduce pain and are safe. Aims: Primary aim is to determine the differences in adverse cardiopulmonary events, vital sign parameters, objective pain, and adjunct fentanyl use during EGD procedures between propofol and ketofol (ketamine-propofol mixture) sedation agents. Secondary aim is to determine the differences in site performance metrics between the two agents. Methods: Retrospective analysis of 90 patients undergoing deep sedation for same-day EGD procedures at a military academic medical centre. Patients were analysed separately via age groups of 2-11 years and 12-18 years. Forty-one patients underwent sedation via propofol, and 49 patients underwent sedation via 1:5 ratio of ketamine to propofol as main agents. Main agents were administered via intravenous loading dose based on 1 mg/kg of propofol followed by a 200-250 mcg/kg/minute infusion. One mcg/kg fentanyl bolus was given when a sedationist perceived patient pain. Results: Ketofol reduced fentanyl use by ~1 mcg/kg compared to propofol in all age groups (p<0.008). Ketofol compared to propofol had less apnoea requiring intervention (3.7% versus 53.8%, p<0.001, ages 2-11 years; and 0% versus 33.3%, p=0.005, ages 12-18 years), and less hypotensive events (3.7% versus 15.4%, p=0.192, ages 2-11 years; and 0% versus 13.3%, p=0.144, ages 12-18 years). There was no difference in LOS between main sedation agents (p>0.008). Conclusions: Ketofol is effective at reducing opioid demand and adverse cardiopulmonary events during EGD procedures compared to propofol in ages 2-18 years. Keywords: Ketofol, Propofol, Fentanyl, Esophagogastroduodenoscopy, and Deep Sedation. Abbreviations: Esophogastroduodenoscopy (EGD), length of stay (LOS), mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), and Children's Hospital of Eastern Ontario Pain Scale (CHEOPS).