Ketofol versus sevoflurane for maintenance of aesthesia in paediatric cardiac catheterization: A prospective double blind study

Abstract

Background Pediatric cardiac anesthesia involves anaesthetizing very small children with complex congenital heart disease. Sevoflurane provides the advantage of rapid induction of anesthesia with short recovery time. Ketofol is a neologism coined to refer to the combination of ketamine and propofol mixed together in one syringe. Ketamine and propofol have opposing influences on blood pressure, heart rate, and SVR. Aim of the work To compare the effectiveness and side effects of ketofol versus sevoflurane for maintenance of aesthesia in pediatric cardiac catheterization. Methods This double blinded randomized study was carried on 90 pediatric patients ASA II and III undergoing cardiac catheterization. Induction was accomplished with titration of 3–5% sevoflurane. Patients were randomly assigned to one of the two study groups. Group K received ketofol mixture (propofol, 4 mg/mL, and ketamine, 2 mg/mL) infusion rate propofol 25–50 mic/kg/min and ketamine 12.5–25 mic/kg/min for maintenance. Group S received sevoflurane 0.5–1 MAC. Changes in recovery time, hemodynamic variables and the incidence of adverse effects were measured. Results Diastolic blood pressure showed significant difference between the study groups at induction p (0.001), 5 min after induction p(0.04), on recovery 0.037, 5 min postoperatively p(0.016), and 10 min postoperatively. The need for vasopressor and MAP decrease >20% compared with baseline did not show significant difference p(0.832). Recovery time was shorter in group S p(.000). The incidence of nausea and vomiting was significantly more in group S p(.000). Emergence agitation was observed in group S in 12(26.6) patients. Watcha scale was significantly lower in group K at 10 min postoperatively p(.001). Conclusions Both propofol–ketamine and sevoflurane provided effective sedation and analgesia during pediatric cardiac catheterization. But propofol–ketamine combination was superior to sevoflurane because the incidence of agitation, nausea and vomiting in patients given sevoflurane was significantly higher than in ketofol group.