Effect of Ketamine/Propofol Admixture on Peri-Induction Hemodynamics: A Systematic Review and Meta-Analysis

Assessing pediatric anesthesia outcomes and prognostic factors: a comparative study of ketamine vs. ketamine + propofol

Objective: To investigate the anesthesia outcomes of ketamine and propofol in pediatric anesthesia and analyze associated prognostic factors. Methods: A retrospective study was conducted on 160 children who underwent anesthesia and operation in Children's Hospital of Nanjing Medical University from 2020 to 2022. The anesthesia outcomes was analyzed by comparing the blood oxygen saturation (SpO2), heart rate (HR), mean arterial pressure (MAP) at before (T1), during (T2) and after (T3) operations, recovery time after anesthesia, post-anesthesia care unit (PACU) stay, adverse reactions, as well as the Steward and FLACC scores between the control and research groups. Univariate analysis and logistic regression analysis were used to identify the prognostic factors in pediatric anesthesia. Results: The changes in SpO2, HR, and MAP were different between the two groups at different time points (P < 0.05). There were significant differences in anesthesia recovery time, PACU stay, Steward and FLACC scores, and incidence of adverse reactions between the two groups (P < 0.05). Logistic regression analysis revealed that operation time ≥ 49.5 minutes (P = 0.001, OR = 3.828, 95% CI: 1.715-8.544) and single use of ketamine for anesthesia (P = 0.048, OR = 2.257, 95% CI: 1.006-5.063) were independent risk factors for postoperative delirium. Conclusion: Combining propofol with ketamine for pediatric anesthesia yields superior clinical outcome compared to using ketamine alone. This combined approach can effectively maintain stable circulation during operation, lead to shorter anesthesia recovery time, ensure high recovery quality, reduce postoperative pain, adverse reaction rate, and risk of post-anesthesia delirium in children, thereby improving the prognosis.

Sedative effect and safety of different doses of S-ketamine in combination with propofol during gastro-duodenoscopy in school-aged children: a prospective, randomized study

Background

Propofol combined with opioids can reduce the dosage of propofol and improve the safety of endoscopy. However, there are few studies on propofol combined with S-ketamine in children undergoing gastro-duodenoscopy. We aim to determine the sedative effect and safety of different doses of S-ketamine in combination with propofol in school-aged children undergoing gastro-duodenoscopy.

Methods

This is a prospective, randomized trial. Totally, 120 school-aged children who underwent gastro-duodenoscopy were randomly allocated into Group P, Group S0.3, Group S0.5 and Group S0.7. During induction, children in Group P, Group S0.3, Group S0.5 and Group S0.7 received 0, 0.3 mg.kg−1, 0.5 mg.kg−1 and 0.7 mg.kg−1 S-ketamine, respectively, following 3 mg.kg−1 propofol injection. During gastro-duodenoscopy, 1 mg.kg−1 of propofol was added according to the condition of the children and the BIS (bispectral index) value. The primary outcome was smooth placement rate of the first endoscope insertion. The secondary outcome was the times of additional propofol, the total amount of propofol, adverse events, recovery time, length of PACU (post anesthesia care unit) stay and endoscopist satisfaction.

Results

The smooth placement rate of the first endoscope insertion in Group P, Group S0.3 and Group S0.5 was significantly lower than that in Group S0.7 (16.70%, 34.50%, 50.00% vs. 83.30%, respectively, P < 0.001). The times of additional propofol in Group S0.3 (P = 0.018), Group S0.5 (P = 0.014) and Group S0.7 (P = 0.001) were significantly less than Group P. The total amount of propofol in Group S0.7 was significantly less than Group P (P < 0.001). The incidence of intraoperative hypotension in Group S0.5 and Group S0.7 was low. Group S0.7 had significantly higher incidence of postoperative dizziness (P = 0.003), longer PACU stay (P = 0.018) and higher endoscopist satisfaction (P = 0.001) than Group P. There was no difference in the recovery time among groups.

Conclusion

S-ketamine (0.7 mg.kg−1) in combination with propofol can provide satisfactory sedative effect and reduce the dosage of propofol in school-aged children undergoing gastro-duodenoscopy, but there are higher incidence of postoperative dizziness and longer PACU stay.