Dexmedetomidine-ketamine and propofol-ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization

Zeynep Tosun, Aynur Akin, Gulen Guler, Aliye Esmaoglu, Adem Boyaci
Journal of Cardiothoracic and Vascular Anesthesia 2006, 20 (4): 515-9

OBJECTIVE: The purpose of this study was to compare the effects of dexmedetomidine-ketamine and propofol-ketamine combinations on hemodynamics, sedation level, and the recovery period in pediatric patients undergoing cardiac catheterization.

DESIGN: Prospective, randomized trial.

SETTING: University hospital.

PARTICIPANTS: Children (n = 44) undergoing cardiac catheterization.

INTERVENTIONS: The dexmedetomidine plus ketamine group (group 1, n = 22) received an infusion over 10 minutes of 1 microg/kg of dexmedetomidine and ketamine, 1 mg/kg, as a bolus, for induction. The patients then received an infusion of 0.7 microg/kg/h of dexmedetomidine and 1 mg/kg/h of ketamine for maintenance. The propofol plus ketamine group (group 2, n = 22) received 1 mg/kg of propofol and 1 mg/kg of ketamine for induction. The patients received 100 microg/kg/min of propofol and 1 mg/kg/h of ketamine by infusion for maintenance. Additional doses of ketamine, 1 mg/kg, were administered when a patient showed discomfort in both groups.

MEASUREMENTS AND MAIN RESULTS: Hemodynamic data, respiratory rate, bispectral index, and sedation scores were recorded after induction and every 15 minutes thereafter. The time to reach a Steward recovery score of 6 was recorded. The heart rate in group 1 was significantly lower (average 10-20 beats/min) than group 2 after induction and throughout the procedure. Ketamine consumption in group 1 was significantly more than in group 2 (2.03 mg/kg/h v 1.25 mg/kg/h) for maintenance (p < 0.01). The recovery time was also longer in group 1 than in group 2 (49.54 v 23.16 minutes, respectively; p < 0.01).

CONCLUSIONS: The dexmedetomidine-ketamine combination was not superior to a propofol-ketamine combination because of insufficient sedation and analgesia and a longer recovery time.

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