Efficacy & safety of Propofol Vs Ketamine

in short surgical / diagnostic procedures in

paediatric age group
Presented by
Dr. Omprakash Sundrani

Dr. Jaya Lalwani (Astt. Prof)

Dr. K.K. Sahare (Asso. Prof)
Dr. K.P. Dubey (Prof & HOD)

Department of Anaesthesiology & Critical care

Pt. J.N.M. Medical College & Dr. B.R.A.M. Hospital
Raipur(C.G.)
 INTRODUCTION
Surgery & Anaesthesia both are traumatic
experience for a child & cause considerable
emotional stress to the child as well as the
parents.

TIVA
 Advantages of Propofol
 Smooth & Rapid induction (Gerald Edelist etal ,
1987)
 Rapid & clear headed recovery ( Kashtan H etal ,
1990)
 Less postop nausea & vomiting (Myles P.S. etal ,
1996)
 Minimum inhibition of cortisol production(Kenyou
CJ etal1985)
 No interaction with haem synthesis (Kenyou CJ etal,
1985)
 Aims & Objectives
To compare Propofol as a sole
anaesthetic agent with Ketamine in
paediatric day care surgery in view of

 Onset , characteristics of induction & duration of action

 Effectiveness & quality of sedation
 Recovery time & Recovery characteristics
 Effect on cardiovascular & respiratory system
 Side effects & complications
 Material & Methods
Inclusion Criteria
 100 patients
 ASA Grade I & II
 Either sex
 3 to 12 yrs age group
 Short duration surgeries or
diagnostic procedures
Exclusion Criteria
 Children below 3 yrs
 Full stomach
 Patients suffering from URI
 Open globe injury, psychiatrics
or patients with seizure disorder
 Patients allergic to egg & soya
 Morbid obesity
 H/O adverse reaction to
anaesthesia & sedation
 Material & Methods

 Group I :- Inj Propofol 1٪ 2.5 mg/kg

+ Inj Fentanyl 2µg/kg for induction &
100 - 300µg/kg/min for maintenance

 GroupII :- Inj Ketamine 2 mg/kg + Inj

Midazolam 0.05mg/kg for induction &
30 – 90µg/kg/min for maintenance
 Material & Methods
Premedication

I.V. Glycopyrrolate 10µg/kg

I.V. Ranitidine 1-2mg/kg
 Material & Methods
Monitoring
HR , BP , SpO2 , RR .

 Preoperatively
 Afterpremedication
 Immediately after induction
 At 5min interval for first 30min
 Every 10min there after upto 2hrs postoperatively
 Material & Methods

Patients were observed in postoperative

period for signs of complete recovery &
were assessed by fast track eligibility
criteria.
Criteria used to determine fast track eligibility after

ambulatory anaesthesia
 Levels of conciousness : Awake(2) / Arousable with minimal
stimulation(1) / Responsive only to tactile stimulation(0)
 Physical Activity : Able to move all extremities on command(2) / Some
weakness in movement of all extremities(1) / Unable to voluntarily move the
extremities(0)
 Haemodynamic Stability : Blood pressure <15% of the baseline MAP
value(2) / Blood pressure between 15% and 30% of the baseline MAP
value(1) / Blood pressure >30% below the baseline MAP value(0)
 Respiratory Stability : Able to breathe deeply(2) / Tachypnea with good
cough(1) / Dyspneic with weak cough(0)
 Oxygen Saturation Status : Maintain value > 90% on room air(2) /
Requires supplemental oxygen (nasal prongs)(1) / Saturation < 90% with
supplemental oxygen(0)
 Postoperative pain assessment : None or mild discomfort(2) / Moderate to
severe pain controlled by i.v. analgesics(1) / Persistent severe pain(0)
 Postoperative Emetic Symptoms : None or mild nausea with no active
vomiting(2) / Transient vomiting or retching(1) / Persistent moderate to severe
nausea and vomiting(0)
 Demographic Profile
Parameters Group I Group II

No: of patients 50 50

Age Range ( yrs ) 3 - 12 3 – 12

Mean Age ( yrs ) 7.68 ± 2.76 7.66 ± 2.74

Sex distribution 30/20 30/20

( M/F )
Weight Range ( kg ) 10 – 30 10 – 30

Mean Weight ( kg ) 19.74 ± 5.41 19.54 ± 5.17

 Induction Time

42.02

42.2
42
41.8
41.6
41.4
41.2 40.78
41
40.8
40.6
40.4
40.2
40
I II

Group
Dose Requirement for Induction

49

50 42.4

45

40
35

30

25

20

15

10 2.48 2.2

0
I II
GROUP

INDUCTION DOSE (mg/ kg) TOTAL INDUCTION DOSE (mg)

 Dose Requirement for
Maintenance
241. 8
250 226. 14
218. 9

200

150
118. 3
Mean

100 79. 16
70. 9

50

0
Inf usion rate ( µg/ kg/ min) Total maintenanc e dose ( mg) Total dose ( mg)

Gr oup I Gr oup I I
Supplementation of Drug for
maintenance

28

30

22
25

20

15

10

0
I II
GROUP
 Distribution according to duration
of Anaesthesia
40
36
34
35
Patients (%)

30

24
25 22 22
20
20

15 12
10
10
6 6
4 4
5

0
25-35 36-45 46-55 56-65 66-75 >75

TIME (min)
Group I Group II
 Distribution according to duration
of surgery
40

34
35
32
Patients (%)

30

24
25
22 22
20
20
16
T
15
12
10
10

4
5
2 2

0
15-25 26-35 36-45 46-55 56-65 >65

Time (min)
Group I Group II
 MEAN (BPM)

90
95
100
105
110
115
120
Pre
operative
After pre
medication
After
induction
10 minutes
after
20 minutes
after
30 minutes
after

Group I
40 minutes
after
interval

50 minutes
after

Group II
60 minutes
after
70 minutes
after
80 minutes
after
90 minutes
after
Mean Heart rate at various time

Post
operative
 MEAN (mmHg)

0
20
40
60
80
100
120
140
Pre
operative
After pre
medication
After
induction
10 min
after
20 min
after
30 min
after

Group I
40 min
after
50 min
after

Group II
60 min
after
70 min
after
various time intervals

80 min
after
90 min
after
Post
Mean Systolic arterial pressure at

operative
 MEAN (mmHg)

0
10
20
30
40
50
60
70
80
90
Pre
operative
After pre
medication
After
induction
10 min
after
induction
20 min
after
induction
30 min
after
induction
40 min

Group I
after
induction
50 min
after
induction
60 min
Group II
after
induction
70 min
after
induction
80 min
at various time interval

after
induction
90 min
after
induction
Mean Diastolic arterial pressure

Post
operative
 Mean RR

0
5
10
15
20
25
Pre operative
After
premedication
After
induction
10 mmin after
induction
20 mmin after
induction
30 mmin after
induction
40 mmin after
induction
50 mmin after
induction
60 mmin after
induction
70 mmin after
induction
time interval

80 mmin after
induction
90 mmin after
induction
Post operative
Mean Respiratory rate at various

Group I
Group II
 PERCENTAGE

0
5
10
15
20
25
30

14
Pain on

0
injection/Thrombophlebitis

24
Spontaneous movements

10
28

Apnoea

8
2
Laryngospasm /
Bronchospasm
10
0

Nystagmus
26
complications

Emergence phenomenon
12
4

Nausea / Vomiting
16
Incidence of perioperative

Group I
Group II
Fast Track Eligibility Criteria at
various time interval

100
96
92
100

90 80
Patients (%)

80

70

60
46
50

40 28
30

20

10

Up t o 30min Up to 60min Up t o 120 min

Time
Gr oup I Gr oup I I
 Quality of Anaesthesia
80

80

60 50
Patients(%)

40

40
20

20 10

0
Excellent Good Poor

GroupI GroupII
 Summary
 There was no significant difference in induction dose &
induction time b/w the two groups
 Infusion rate for maintenance of anaesthesia is more in
propofol group
 Arterial B.P. decreased in Propofol group & increase was
seen in Ketamine group
 Increase in Heart rate is less with Propofol
 Incidence of Apnoea is more with Propofol
 Pain on injection was seen only with Propofol
 Incidence of Spontaneous movement was more in Propofol
group
 Laryngospasm / Bronchospasm was more in Ketamine
group
 Conclusion

Propofol provides smooth Induction with

rapid and smooth recovery