Effect of ketofol versus propofol as an induction agent on ease of laryngeal mask airway insertion conditions and hemodynamic stability in pediatrics: an observational prospective cohort study

Abstract

BackgroundLaryngeal mask airway is a supraglottic airway device which has led to a fundamental change in the management of modern general anesthesia. In the present study; we evaluated the laryngeal mask airway insertion conditions and hemodynamic changes comparing ketamine-propofol mixture (ketofol) with propofol. The study was to compare the ketamine–propofol mixture (ketofol) with propofolon the ease of laryngeal mask airway insertion conditions and hemodynamic effects for induction of general anesthesia.MethodsOne hundred twenty pediatric patients were recruited and assigned to two groups (60 each). Group KP = ketofol, group P = propofol. Insertion conditions were compared using a Chi-square test while hemodynamic variables were compared using the independentt-test. Statistical significance was stated at p-value< 0.05.ResultsLaryngeal mask airway insertion summed score was nearly similar between the two groups. Mean blood pressure and heart rate were maintained higher in ketofol group while a significant drop was observed in the propofol group. The time from the Laryngeal mask airway placement to the return of spontaneous ventilation was significantly longer in propofol group (240 s [range = 60–360 s]) compared with ketofol group (180 s [range = 30–320 s]) (p = 0.005).ConclusionsLaryngeal mask airway insertion condition summed score was comparable in both ketofol and propofol group. Ketofol provided equivalent laryngeal mask airway insertion conditions while maximizing hemodynamics and minimizing apnea time. Ketofol can be used as an alternative to propofol for laryngeal mask airway insertion in pediatrics.

Frequency of excellent Laryngeal mask airway insertion conditions in children undergoing elective surgery: A comparison of propofol with ketofol.

“…Though in terms of mean arterial blood pressure and duration of apnea ketofol was better than propofol. 20 Another study showed results contrary to ours with no significant difference between two groups for jaw relaxation and adverse airway reflexes in elderly patients. 21 Gupta A et al also showed PK (propofol-ketamine) group with least success in n= 12 (40%) patients as compared to 13 (43.33%) patients in Group PF (propofol-fentanyl) and in 26 (86.67%) patients in Group PB (propfol-botarphanol).…”

Reliable and rapid smooth extubation after Ketofol for induction of general anesthesia in Laparoscopic Drilling of polycystic ovary: A randomized controlled trial.

“…Recently, Aberra et al, in a study done on 120 pediatric patients aged from 2 to 15 years undergoing elective ophthalmic surgical procedures under general anesthesia using laryngeal mask airway (LMA) to compare the ketamine-propofol mixture (ketofol) with propofol only on the ease of laryngeal mask airway insertion conditions and hemodynamic effects during induction of general anesthesia, found that 54 patients in the ketofol group compared to 52 in the propofol group developed no cough, 6 patients in the ketofol group compared to 7 patients in the propofol group developed a slight cough (coughing which can occur immediately after LMA and subside by itself) and 1 patient in the propofol group developed gross cough (coughing which needs deepening of anesthesia to be relieved ) with no signi cant difference between them. (17) We also, reported that the sedation scores during suction and extubation were signi cantly lower in the KP group compared to the P group. We attributed this good level of sedation during suction and extubation to the analgesic effect of ketamine.…”

“…They concluded that Ketofol provided equivalent laryngeal mask airway insertion conditions and it can be used as alternative propofol for LMA insertion. (17) Patients in KP group showed higher level of sedation during the suctioning and extubation procedures when compared to those of the P group. This may be explained by the more sedative and more decreasing of the airway re exes of ketofol during recovery in such short surgical procedures.…”

“…it keeps the bene ts of each drug and excluding the unwanted effects ( analgesia of ketamine without increasing airway re exes or sympathetic stimulation) and (Depressive effect of propofol on airway re exes without hemodynamic instability) due to the additive effect of GABA agonism by propofol and (NMDA) antagonism by ketamine. 17 This may explain more hemodynamic stability, smoothness of extubation, decreased airway re exes, and more sedative effect during suctioning and recovery in the KP group.…”

“…(13,14) Ketofol (ketamine-propofol mixture) as an induction agent drug and its effect on hemodynamics has been studied previously. (15,16) Its effect on the airway responses during induction of anesthesia was studied by Aberra et al (17) We hypothesized that giving ketofol as an induction agent getting the bene cial effects of both medications would favorably affect both the hemodynamics and the airway response during extubation.…”