Comparison of the haemodynamic changes and adverse effects of two different concentrations of ketofol in paediatric oncology patients undergoing procedural sedation: A randomized study

Abstract

Background: Procedural sedation is the safe and effective control of pain, anxiety, and motion so as to allow necessary procedures to be performed vis-a-vis bone marrow aspiration and intrathecal injections which are common in children with hematological diseases. Ketamine or propofol commonly used can result in hypertension and vomiting with ketamine, while hypotension and anti-emesis occur with propofol. Recently, the combination of both drugs (ketofol) has been introduced to minimize these effects. This study compared different ratios of ketofol (1:2 and 1:3) for procedural sedation in pediatric oncology patients. Methods: Sixty pediatric oncology patients aged 1–15 years scheduled for procedural sedation were randomized into Group KT2 (ratio 1:2) or KT3 (ratio 1:3). Group KT2 was made up of 2 mg/mL ketamine and 4 mg/mL propofol, while KT3 was 2 mg/mL of ketamine and 6 mg/mL of propofol. Administration was initially at 0.5 mL/kg and then 0.25 mL/kg when the Ramsay Sedation Score <4. Hemodynamic changes, respiratory rate (RR), oxygen saturation, and adverse events were evaluated. Results: The two groups were comparable with respect to demographic profile. The mean arterial pressure (MAP) and systolic blood pressure (SBP) were lower and significantly different in the KT3 (P = 0.011 and P = 0.046, respectively). There was no significant difference in the mean heart rate between the groups, P = 0.4121. Reduced oxygen saturation was noted in 5 (16.7%) patients in the KT2 group and 8 (26.7%) patients in the KT3 group, although this was not statistically significant. The incidence of vomiting and hallucination was noted in 2 (3.3%) patients and 1 (1.7%) patient, respectively; both were in Group KT2, P = 0.297. Conclusion: MAP and SBP were lower in the KT3 (ketofol 1:3) group compared to the KT2 (ketofol 1:2) group. RR and oxygen saturation were also comparable between the groups. Adverse events were not significantly different. However, vomiting and hallucination were noted more in the ketofol 1:2, while the reduction in oxygen saturation was more among patients in the ketofol group 1:3.

Keywords

• hematological malignancy
• ketofol
• procedural sedation