Dexmedetomedine-Ketamine versus Propofol-Ketamine as anaesthetic agents in paediatric cardiac catheterization

Abstract

Introduction: Anaesthesia for these patients undergoing for interventional procedures in paediatric patients with congenital cardiac anomalies remains a challenge for the anaesthesiologist. There are no specific techniques to follow and anaesthetic procedure is modified according to the cardiac anomalies, clinical condition of the patients and the cardiologist’s requirements. Basically the anaesthesiologist can either provide sedation or general anaesthesia. Objective: The aim of this study was to compare the sedation level, haemodynamic effects and recovery patterns in paediatric patients undergoing sedation for cardiac catheterization either with dexmedetomidine-ketamine or propofol-ketamine combination. Materials & Methods: Sixty patients between the ages of 1 to 12 years were scheduled for cardiac catheterization at Cardiac Catheterization Laboratory of Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, India for a period of six months (April to September 2012) for evaluation and intervention of congenital heart disease. Patients were randomly divided into 2 groups of 30 each. All patients were premedicated with intravenous midazolam (0.05mg/kg upto 2 mg) and glycopyrrolate (10 ?g/kg) 5 minutes before the procedure and anaesthesia was induced with ketamine 1mg/kg. The dexmedetomidine-ketamine group (group D, n=30), received dexmedetomidine 1?g/kg over 10 minutes. 19 JAFMC Bangladesh. Vol 10, No 1 (June) 2014 Propfol-ketamine group (group P, n=30) received 50?g/kg/min of propofol by infusion. Heart rate (HR), Systolic Blood Pressure ( SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), peripheral oxygen saturation (SpO2), respiratory rate (RR), and modified Steward score of all patients was recorded at baseline, after induction and every 10 minutes thereafter. The time to reach a modified Steward score of >or=6 was recorded. Results: Recovery time was significantly less in group P (mean 39±12.32mins) than in group D (mean 48±15.15mins). Statistical significant difference (p<0.05) was found between group D and P regarding systolic blood pressure (64.48 ± 11.21mmHg vs 56.06 ± 10.13mmHg), diastolic blood pressure (40.08 ± 8.00 mmHg vs 35.05 ± 6.64 mmHg) and mean arterial pressure (48.32 ± 8.34 mmHg vs 42.39 ± 7.98 mmHg). For maintenance less additional ketamine was required in group D (22.76±11.87mg) than group P (25.10±20.73mg) but this was not statistically significant. Conclusion: Clinical outcome of both groups was similar and there was no significant difference in the recovery patterns and haemodynamic status and hence it is concluded that either of the techniques is suitable for children undergoing catheterization and interventional procedures. DOI: http://dx.doi.org/10.3329/jafmc.v10i1.22898 Journal of Armed Forces Medical College Bangladesh Vol.10(1) 2014

Comparison of dexmedetomidine and ketamine versus propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterization laboratory

“…which compared DK and PK as anesthetic agents in pediatric cardiac catheterization, clinical outcome of both groups was similar and there was no significant difference in the recovery patterns and hemodynamic status. [ 11 ] In our study, we had similar results in terms of BP, SpO 2 and Respiratory rate between the two groups.…”

Dexmedetomidine–propofol vs ketamine–propofol anaesthesia in paediatric and young adult patients undergoing device closure procedures in cardiac catheterisation laboratory: An open label randomised trial

“…[ 27 ] In a study similar to ours, the authors reported more frequent agitation during recovery and a longer duration to regain baseline mental status in the ketamine group compared to the propofol group. [ 28 ] Our study did not show any significant difference in the cardiorespiratory or haemodynamic parameters patients in both treatment arms. There was overall greater tachycardia with KP as compared with DP and transient decrease in SBP, DBP, and MAP with reflex decrease in HR with DP, but neither of these findings were significantly different.…”

A Comparison of Ketamine-Dexmedetomidine versus Ketamine-Propofolfor Sedation in Children during Upper Gastrointestinal Endoscopy

“…They also reported less required ketamine doses in group D (22.76 ± 11.87 mg) when compared to group P (25.10 ± 20.73 mg) but this wasn't significant [29].…”

“…Ketamine was described as safe, effective and simple and was firstly hoped to be used as a sole anesthetic medication causing loss of consciousness, amnesia, and analgesia. However, its use rapidly decreased because of its associated psychological effects and the presence of other alternative anesthetic agents [29]. Combination of ketamine with either propofol or dexmedetomidine allows usage of lower doses adds synergism and decreases side effects.…”