The effect of ketamine on tracheal intubating conditions without neuromuscular blockade during sevoflurane induction in children

Abstract

Purpose The purpose of this study was to investigate the effect of ketamine on intubating conditions for tracheal intubation during anesthesia induction with sevoflurane and alfentanil in pediatric patients. Methods After obtaining parental consents, 50 children, aged 3-10 years, were randomly allocated into two groups to receive either i.v. ketamine 0.5 mg/kg (ketamine group, n = 25) or i.v. saline 5 ml (control saline group, n = 25). One minute after injection of the study drug (ketamine or saline), anesthesia was induced with 5% sevoflurane, followed by injection of alfentanil 10 lg/kg 1 min later. The trachea was intubated 4 min after inhalational induction of anesthesia. Acceptable intubation was defined as excellent or good intubating conditions. Mean arterial pressure (MAP) and heart rate (HR) were recorded during the induction period. Results The percentage of patients with acceptable intubating conditions was higher in the ketamine group (87%) than in the control group (52%) (P = 0.0129). MAP before intubation was significantly lower in the control group than in the ketamine group (P = 0.001).Conclusion This study demonstrated that administration of ketamine 0.5 mg/kg could improve intubating conditions for tracheal intubation without neuromuscular blockade and preserve hemodynamic stability during sevoflurane inhalation induction with alfentanil in children.

Ketamine: Use in Anesthesia

“…After tonsillectomy (n = 60), ketamine 0.5 mg/kg added to fentanyl 1 mg/kg improved analgesia without delaying hospital discharge . Also, ketamine 0.5 mg/kg added to anesthesia induction with sevoflurane 5% and alfentanil 10 μg/kg (n = 50) improved intubation conditions in spontaneously breathing children while preserving hemodynamic stability . Similarly, in children with congenital heart disease (n = 50), hemodynamics were better preserved and adverse respiratory effects were fewer and milder after anesthesia induction with IM ketamine 5 mg/kg as compared with sevoflurane 3% .…”

Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane

“…Furthermore, sevoflurane inhalational induction can provide excellent conditions for tracheal intubation or laryngeal mask airway (LMA) insertion [2]. Although many studies so far have demonstrated that sevoflurane is the most favorable violated agent for inhalational induction without irritating airway which may result in breath holding or laryngospasm [3], many children still refuse to accept the mask.…”

Ketamine use in current clinical practice

“…When 0.5 mg/kg of ketamine was added to 1 mcg/kg fentanyl, analgesia improved without delaying hospital discharge after a tonsillectomy [67] . Additionally, 0.5 mg/kg ketamine with 5% sevoflurane and alfentanil 10 mcg/kg improved intubating conditions in children, while preserving spontaneous breathing and hemodynamic stability [68] . During pediatric cleft palate surgeries, surgical site infiltration with either bupivacaine or ketamine provides adequate analgesia without major side effects.…”