An analytical study of Comparison between Ketamine - Dexmedetomidine versus Ketamine - Propofol for Sedation in Children Undergoing Minor Cardiac Procedures in a Cardiac Catheterization Laboratory
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Keywords

Pediatric Cardiac surgeries
Cardiac anesthesia
Ketamine
Propofol
Dexmedetomidine

How to Cite

Mamde, D. R., & Mamde, D. A. (2021). An analytical study of Comparison between Ketamine - Dexmedetomidine versus Ketamine - Propofol for Sedation in Children Undergoing Minor Cardiac Procedures in a Cardiac Catheterization Laboratory. VIMS Health Science Journal , 8(1), 34-38. https://doi.org/10.46858/vimshsj.8107

Abstract

Background: The management of children with heart diseases has been a major challenge for cardiac anesthetists. The anesthetic technique to be used should be easy, safer and provide cardiac stability throughout the operation. So cardiac interventionist prefer deep sedation with the patient breathing spontaneously and painlessly in the room. Propofol, Ketamine along with other combinations drugs have been used worldwide by cardiac anesthetists to achieve these goals. We carried out this study to evaluate the combination drugs for pediatric cardiac surgeries which are Ketamine – Dexmedetomidine (KD) and Ketamine – Propofol (KP). Methodology: This study was conducted in the Department of Cardiology. A total number of 80 cases were selected, 40 from each comparative groups of Ketamine – Dexmedetomidine (KD) and Ketamine – Propofol (KP). Patient data was categorized into age, sex, procedure done and recovery time, analgesic boluses required and hemodynamic parameters during the surgery. Results: Mean age in KD group was 5.24 ± 1.25 years and in KP group was 4.95 ± 1.86 years. There were 24 males (60%) and 16 females (40%) in KD group and 22 males (55%) and 18 females (45%) in KP group. Most common procedures done in both the groups was ASD for device closure done in 12 patients (30%) in KD group and 13 patients (32.5%) in KP group. There was significant difference between the mean recovery time and number of ketamine boluses consumption in both the groups. (p<0.05) Heart rate was significantly lower in KD group at 5, 10, 15 and 20 min post induction when compared to KP group. No statistically significance was found in difference between the Mean Respiratory rate and MAP. Conclusion: Our study concludes that the use of KD combination is relatively safe, practical alternative, we did not find any hemodynamic or respiratory effects during the cardiac procedures but there was some delayed recovery.

https://doi.org/10.46858/vimshsj.8107
PDF Downloads : 28    VIEW PDF

References

Argent AC, Balachandran R, Vaidyanathan B, Khan A, Kumar RK. Management of undernutrition and failure to thrive in children with congenital heart disease in low-and middle-income countries. Cardiology in the Young. 2017 Dec;27(S6):S22-30.

Hinton RB, Ware SM. Heart failure in pediatric patients with congenital heart disease. Circulation research. 2017 Mar 17;120(6):978-94.

Williams GD, Jones TK, Kimberley AH, et al: The hemodynamic effects of propofol in children with congenital heart disease. Anesth Analg 89:1411-1416, 1999.

Oklu E, Bulutcu FS, Yalc?n Y, et al: Which anesthetic agent alters the hemodynamic status during pediatric catheterization? Comparison of propofol versus ketamine. J Cardiothorac Vasc Anesth 17:686-690,2003

Jobeir A, Galal MO, Bulbul ZR, et al: Use of low-dose ketamine and/or midazolam for pediatric cardiac catheterization: Is an anesthesiologist needed? Pediatr Cardiol 24:236-243, 2003.

Jobeir A, Galal MO, Bulbul ZR, et al: Use of low-dose ketamine and/or midazolam for pediatric cardiac catheterization: Is an anesthesiologist needed? Pediatr Cardiol 24:236-243, 2003.

Kogan A, Efrat R, Katz J: Propofol-ketamine mixture for anesthesia in pediatric patients undergoing cardiac catheterization. J Cardiothorac Vasc Anesth 17:691- 693, 2003.

Bhana N, Goa KL, McClellan KJ: Dexmedetomidine. Drugs 59:263-268, 2000

Xu J, Zhou G, Li Y, Li N. Benefits of ultra-fast-track anesthesia for children with congenital heart disease undergoing cardiac surgery. BMC pediatrics. 2019 Dec;19(1):1-5.

Guzzetta NA, Williams GD. Current use of factor concentrates in pediatric cardiac anesthesia. Pediatric Anesthesia. 2017 Jul;27(7):678-87.

Kanchi M. History of Cardiac Anesthesia in India. Journal of cardiothoracic and vascular anesthesia. 2019 Feb 1;33(2):582.

Sarkar M. Cardiac anesthesia as super-specialty: Need of the hour!. Indian Journal of Clinical Anaesthesia. 2019 Jan;6(1):3-5.

Nasr VG, DiNardo JA. The pediatric cardiac anesthesia handbook. Wiley Blackwell; 2017 May 15.

Ard J, Doyle W, Bekker A: Awake craniotomy with Dexmedetomidine in pediatric patients. J Neurosurg Anesthesiol 15:263-266, 2003

Tosun Z, Akin A, Guler G, Esmaoglu A, Boyaci A. Dexmedetomidine?ketamine and propofol?ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization. J Cardiothorac Vasc Anesth 2006;20:515?9.

Ali NP, Kanchi M, Singh S, Prasad A, Kanase N. Dexmedetomedine?Ketamine versus Propofol?Ketamine as anaesthetic agents in paediatric cardiac catheterization. J Armed Forces Med Coll Bangladesh 2015;10:19?24.

Joshi VS, Kollu SS, Sharma RM. Comparison of dexmedetomidine and ketamine versus propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterization laboratory. Annals of cardiac anaesthesia. 2017 Oct;20(4):422.

Heard C, Burrows F, Johnson K, Joshi P, Houck J, Lerman J. A comparison of dexmedetomidine?midazolam with propofol for maintenance of anesthesia in children undergoing magnetic resonance imaging. Anesth Analg 008;107:1832?9.

Jaikaria A, Thakur S, Singhal P, Chauhan D, Jayam C, Syal K. A comparison of oral midazolam-ketamine, dexmedetomidine-fentanyl, and dexmedetomidine- ketamine combinations as sedative agents in pediatric dentistry: A triple-blinded randomized controlled trial. Contemporary clinical dentistry. 2018 Sep;9(Suppl 2):S197.

Qian B, Zheng W, Shi J, Chen Z, Guo Y, Yao Y. Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial. Drug Design, Development and Therapy. 2020;14:3559.

Bali BK, Patel A. Study of KETODEX; Combination of Dexmedetomidine and Ketamine in Upper Gastrointestinal Scopy in Adults: Observational Study. J Med Sci Clin Res. 2017;5(06):23986-93.

Chayapathi V, Kalra M, Bakshi AS, Mahajan A. A comparison of ketamine+ midazolam to propofol for procedural sedation for lumbar puncture in pediatric oncology by nonanesthesiologists—a randomized comparative trial. Pediatric blood & cancer. 2018 Aug;65(8):e27108.

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Copyright (c) 2021 Dr. Rahul Mamde, Dr. Ambika Mamde

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