Safety and efficacy of ketamine-propofol in pediatric magnetic resonance imaging: A prospective study

• Published in: Journal of critical care 2024-06, Vol.81, p.154710, Article 154710
• Main Authors: Abbas, Awais, Shah, Muhammad Abid, Abbas, Qalab, Iqbal, Iram, Rehman, Naveed, Rasool, Aniqa Abdul, Shah, Ibrahim, Khan, Shahriyar, Cheema, Zahra
• Format: Article
• Language: English
• Subjects: Anesthesia; Critical care; Ketamine; Magnetic resonance imaging; MRI; Pediatrics; Procedural sedation and analgesia; Propofol; Safety
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154710

Procedural sedation and analgesia (PSA) is a technique involving sedative and analgesic agents to suppress consciousness to varying degrees, providing pain relief simultaneously. The demand for PSA in pediatric populations has increased exponentially as many unpleasant procedures warrant optimum sedation and analgesia. The aim of current study is to evaluate the safety and efficacy of low-dose ketamine and propofol combination in pediatric patients undergoing diagnostic magnetic resonance imaging (MRI). A prospective observational study was performed from July 2020 to January 2022. Patients aged six months to 18 years, weighing more than 5 kg, and undergoing an MRI with an American Society of Anesthesiology (ASA) classification of two or less than two and a Mallampati score of two or less than two were enrolled through a convenience sampling technique. Continuous monitoring of vitals signs was done, and data was collected for drugs doses, duration of sedation, recovery time, adverse events (apnea, hypoxia, failure to sedate). A total of 218 patients were included in the final analysis. The mean age of study population was 4.0 ± 3.2 years, with 60.4% (n = 131) males. MRI was successfully completed under sedation in 213 (97.7%) patients. Indications for MRI were seizure disorders (n = 99, 45.4%) and global developmental delay (GDD) (n = 89, 40.8%). The mean initial dose of ketamine administered was 0.9 ± 0.2 mg/kg, titrated up to a mean total dose of 1.2 ± 0.5 mg/kg. mean initial dose of propofol was 1.1 ± 0.4 mg/kg and titrated to a mean total dose of 2.7 ± 1.4 mg/kg. The mean duration of MRI was 43.8 min, and 81.7% of the patients recovered in less than 5 min. Most patients had respiratory and hemodynamic stability, and only four required suction. This study showed that a combination of low-dose ketamine followed by propofol titration drug is a feasible technique for PSA in pediatric patients undergoing MRI.