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Efficacy of ketamine and midazolam as co‐induction agents with propofol for laryngeal mask insertion in children
Author(s) -
GOEL SHIBA,
BHARDWAJ NEERJA,
JAIN KAJAL
Publication year - 2008
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2008.02563.x
Subject(s) - medicine , propofol , midazolam , ketamine , anesthesia , sedation
Summary Objectives: Use of midazolam and ketamine lowers the induction dose of propofol (co‐induction) producing hemodynamic stability. Background: Large doses of propofol needed for induction and laryngeal mask (LM) insertion in children may be associated with hemodynamic and respiratory effects. Co‐induction has the advantage of reducing dose and therefore maintaining hemodynamic stability. Aim: To examine the effect of co‐induction on hemodynamics, LM insertion and recovery in children. Methods/Materials: A prospective, randomized, double‐blind, controlled study was conducted in 60 ASA I/II children, age 1–8 years. Normal saline, ketamine 0.5 mg·kg −1 , midazolam 0.05 mg·kg −1 were administered in groups P (propofol), PK (propofol–ketamine) and PM (propofol–midazolam), respectively, 2 min prior to the administration of the induction dose of propofol. Propofol 3.5 mg·kg −1 (group P) or 2.5 mg·kg −1 (groups PK and PM) was used for induction, LM inserted 30 s later and insertion conditions assessed. Heart rate and blood pressure were recorded immediately after propofol bolus, then every min till 2 min after LMA insertion. Recovery was assessed using Steward’s Score. Result: In group P, systolic blood pressure (SBP) showed a significantly greater decrease compared to group PK and group PM ( P < 0.005). Only 5% of patients in groups PK and PM showed >20% fall in SBP compared to 89% in group P ( P < 0.005). More children in groups PK and PM had acceptable conditions for LM insertion compared to group P ( P < 0.05). The time to achieve Steward Score of 6 was longer in groups PK and PM compared to group P ( P < 0.005). Conclusion: In children, the combination of propofol with ketamine or midazolam produces stable hemodynamics and improved LM insertion conditions but is associated with delayed recovery.