Comparison of ketamine and ketofol for deep sedation and analgesia in children undergoing laser procedure

• Published in: Lasers in medical science 2017-09, Vol.32 (7), p.1525-1533
• Main Authors: Stevic, Marija, Ristic, Nina, Budic, Ivana, Ladjevic, Nebojsa, Trifunovic, Branislav, Rakic, Ivan, Majstorovic, Marko, Burazor, Ivana, Simic, Dusica
• Format: Article
• Language: English
• Subjects: Analgesia; Analgesia - adverse effects; Anesthesia; Anesthetics, Intravenous; Apnea; Carbon dioxide; Child; Child, Preschool; Children; Clinical outcomes; Deep Sedation - adverse effects; Dentistry; Female; Fentanyl; Humans; Hypertension; Ketamine; Ketamine - therapeutic use; Laser Therapy - adverse effects; Lasers; Male; Medical personnel; Medicine; Medicine & Public Health; Midazolam; Optical Devices; Optics; Original Article; Oximetry; Pain perception; Parents; Patient safety; Patient Satisfaction; Patients; Pediatrics; Photonics; Physicians; Prospective Studies; Pulse duration; Quantum Optics; ROC Curve; Stability analysis; Statistical analysis; Statistical tests; Surveys and Questionnaires; Tachycardia; Wavelength
• ISSN: 0268-8921; 1435-604X
• DOI: 10.1007/s10103-017-2275-x

The aim of our study was to research and evaluate cardiovascular and respiratory stability, clinical efficacy, and safety of two different anesthetic agents in pediatric patients who underwent Pulse dye (wavelength 595 nm, pulse duration 0–40 ms, power 0–40 J) and CO 2 (wavelength 10,600 nm, intensity-fraxel mod with SX index 4 to 8, power 0–30 W) laser procedure. This prospective non-blinded study included 203 pediatric patients ASA I-II, aged between 1 month and 12 years who underwent short-term procedural sedation and analgesia for the laser procedure. After oral premedication with midazolam, 103 children were analgo-sedated with ketamine and fentanyl (K group) and 100 with ketofol and fentanyl (KT group). Vital signs, applied drug doses, pulse oximetry, and parental satisfaction questionnaire were used to compare these two groups. Statistical differences were tested using Student’s t test, Mann-Whitney U test, chi-square test, and Fisher’s exact test. Receiver operating characteristic (ROC) curve analysis was used to assess the cut-off value of the duration of anesthesia predicting apnea. Tachycardia was recorded in a significantly higher number of patients who received ketamine as the anesthetic agent (35.9 vs. 3% respectively). Hypertension was also significantly more frequent in patients who received ketamine in comparison with patients who received ketofol (25.2 vs. 3%). Laryngospasm was not observed in both examined groups. There was no statistically significant difference between groups in satisfaction of parents and doctors. Apnea and respiratory depression occurred significantly more frequent in ketofol than in ketamine group (12 vs. 0.97% and 13 vs. 0%). Based on ROC analysis for apnea, we found a significantly higher number of patients with apnea in the ketofol group when duration of anesthesia was longer than 17 min. Our study has shown that ketofol is more comfortable than ketamine in short-term laser procedures in children, causing less hemodynamic alteration with mild respiratory depression and less post-procedural adverse events.