Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.03.002
Brazilian Journal of Anesthesiology
Scientific Article

Ketamine-propofol sedation in circumcision

Sedação com cetamina-propofol em circuncisão

Handan Gulec; Saziye Sahin; Esra Ozayar; Semih Degerli; Fatma Bercin; Osman Ozdemir

http://dx.doi.org/10.1016/j.bjane.2014.03.002 Braz J Anesthesiol, vol.65, n5, p.367-370, 2015
PDF English
PDF Português
Downloads: 0
Views: 994

Abstract

ABSTRACTBACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation.METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II.RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p < 0.050).CONCLUSION: Propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

Keywords

Ketamine-propofol, Sedation, Circumcision

Resumo

RESUMOJUSTIFICATIVA E OBJETIVO: Comparar os efeitos terapêuticos da cetamina isolada ou combinação de cetamina-propofol em analgesia, sedação, tempo de recuperação e efeitos colaterais em crianças pré-medicadas com midazolam-cetamina-atropina programadas para procedimentos de circuncisão.MÉTODOS: 60 crianças, estado físico ASA I-II (de acordo com a classificação da Sociedade Americana de Anestesiologistas), com idades entre três e nove anos, submetidas a procedimentos de circuncisão sob sedação, foram recrutadas de acordo com um protocolo de randomização duplo-cego aprovado pelo Conselho de Revisão Institucional. Os pacientes foram randomizados e alocados em dois grupos com o uso do método de envelopes lacrados. Ambos os grupos receberam uma mistura de midazolam 0,05 mg kg-1 + cetamina 3 mg kg-1 + atropina 0,02 mg kg-1 por via intramuscular, na presença dos pais na área de intervenções pré-operatórias. A indução foi realizada com propofol-cetamina no Grupo I ou cetamina isolada no Grupo II.RESULTADOS: Nas comparações entre os grupos foram observadas a idade, o peso, a pressão arterial sistólica inicial e a diferença em relação à taxa de pulso inicial (p > 0,050). A pressão arterial diastólica inicial e as mensurações seriadas subsequentes nos minutos 5, 10, 15 e 20 da pressão arterial sistólica, pressão arterial diastólica e taxa de pulso do grupo cetamina foram significativamente maiores (p < 0,050).CONCLUSÃO: Cetamina-propofol (cetofol) proporcionou melhor qualidade de sedação e estabilidade hemodinâmica que cetamina isolada em cirurgias pediátricas de circuncisão. Não foram observadas complicações significativas durante a sedação nos dois grupos. Portanto, cetofol parece ser um método de sedação eficaz e seguro para procedimentos de circuncisão.

Palavras-chave

Cetamina-propofol, Sedação, Circuncisão

References

Choi WY, Irwin MG, Hui TW,. EMLA cream versus dorsal penile nerve block for postcircumcision analgesia in children. Anesth Analg. 2003;96:396-9.

Aouad MT, Moussa AR, Dagher CM,. Addition of ketamine to propofol for initiation of procedural anesthesia in children reduces propofol consumption and preserves hemodynamic sta- bility. Acta Anaesthesiol Scand. 2008;52:561-5.

Aydin Erden I, Gulsun Pamuk A, Akinci SB,. Comparison of propofol-fentanyl with propofol-fentanyl-ketamine combina- tion in pediatric patients undergoing interventional radiology procedures. Pediatr Anesth. 2009;19:500-6.

Akin A, Esmaoglu A, Guler G,. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatr Cardiol. 2005;26:553-7.

da Silva PSL, de Aguiar VE, Waisberg DR,. Use of ketofol for procedural sedation and analgesia in children with hemato- logical diseases. Pediatr Int. 2011;53:62-7.

Demiraran Y, Korkut E, Tamer A,. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: a prospective, randomized study. Can J Gastroenterol. 2007;21:25-9.

Murphy PG, Myers DS, Davies MJ,. The antioxidant potential of propofol (2,6-diisopropylphenol). Br J Anaesth. 1992;68:613-8.

Mikawa K, Akamatsu H, Nishina K,. Propofol inhibits human neutropil functions. Anesth Analg. 1998;87:695-700.

Ozkan-Seyhan T, Sungur MO, Senturk E,. BIS quided sedation with propofol during spinal anaesthesia: influence of anaesthetic level on sedation requirement. Br J Anaesth. 2006;6:645-9.

Ikeda T, Kazama T, Sessler DI,. Induction of anesthesia with ketamine reduces the magnitude of redistribution hypothermia. Anesth Analg. 2001;93:934-8.

Serour F, Cohen A, Mandelberg A,. Dorsal penile nerve block in children undergoing circumcision in a day-care surgery. Can J Anaesth. 1996;43:954-8.

Bhananker SM, Posner KL, Cheney FW,. Injury and liabil- ity associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006;104:228-34.

Bruhn J, Myles PS, Sneyd R,. Depth of anaesthesia moni- toring: what's available, what's validated and what's next?. Br J Anaesth. 2006;97:85-94.

Hesselgard K, Larsson S, Romner B,. Validity and reliability of the Behavioural Observational Pain Scale for postoperative pain measurement in children 1-7 years of age. Pediatr Crit Care Med. 2007;8:102-8.

Suraseranivongse S, Santawat U, Kraiprasit K,. Cross- validation of composite pain scale for preschool children within 24 hours of surgery. Br J Anaesth. 2001;87:400-5.

DeJonghe B, Cook D, AppereDeVecchi C,. Using and understanding sedation scoring systems: a systematic review. Intensive Care Med. 2000;26:275-85.

Hohener D, Blumenthal S, Borgeat A. Sedation and regional I in the adult patient. Br J Anaesth. 2008;100:8-16..

Fredette ME, Lightdale JR. Endoscopic sedation in pediatric practice. Endosc Clin N Am. 2008;18:739-51.

Sakai T, Singh H, Mi WD,. The effect of ketamine on clin- ical endpoints of hypnosis and EEG variables during propofol infusion. Acta Anaesthesiol Scand. 1999;43:212-6.

David H, Shipp J. A randomized controlled trial of ketamine/ propofol versus propofol alone for emergency department pro- cedural sedation. Ann Emerg Med. 2011;57:435-41.

Shah A, Mosdossy G, McLeod S,. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011;57:425-33.

5dcdc2eb0e8825d82bbf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections