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- Title
Efficacy of ketamine and midazolam as co-induction agents with propofol for laryngeal mask insertion in children.
- Authors
GOEL, SHIBA; BHARDWAJ, NEERJA; JAIN, KAJAL
- Abstract
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.
- Subjects
MIDAZOLAM; KETAMINE; CONDUCTION anesthesia in children; PEDIATRIC anesthesia; HEMODYNAMICS; PEDIATRICS
- Publication
Pediatric Anesthesia, 2008, Vol 18, Issue 7, p628
- ISSN
1155-5645
- Publication type
Article
- DOI
10.1111/j.1460-9592.2008.02563.x