Effect of Ketamine-Sufentanil and Ketamine-Midazolam to Induce Sedation and Analgesia in Pediatric with Lumbar Puncture or Bone Marrow Aspiration
AbstractBackground: The combination of sedative and analgesic drugs has a favorable effect on pain management and sedation during painful procedures in pediatrics. Therefore, our aim was to compare the effect of sedation and analgesia of ketamine-sufentanil and ketamine-midazolam in painful procedures in children with blood malignancies. Methods: This double-blind, clinical trial was performed on 82 children with malignancy who had indication of painful diagnostic intervention; patients were randomly divided into two groups of ketamine-sufentanil (KS) and ketamine -midazolam (KM). In KS group, sufentanil 0.5mcg/ kg and ketamine 1mg/ kg and in the KM group, ketamine 1mg/ kg, and midazolam 0.1mg/ kg bolus were prescribed. In either group, hemodynamic indicators of sedation, side effects, duration of effectiveness were recorded. Data were analyzed using SPSS 20. Results: Sedation based on Ramsay sedation score was not significantly different between the two groups (p= 0.39). The average recovery time in the midazolam-ketamine group was higher (p-value= 0.076). Conclusion: The combination of ketamine-sufentanil and ketamine-midazolam was effective in sedation and analgesia in bone marrow aspiration and lumber puncture; side effects were however, lower in ketamine-midazolam group.
Child CoPAo, Health F. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793-7.
Anghelescu DL, Burgoyne LL, Faughnan LG, Hankins GM, Smeltzer MP, Pui C-H. Prospective randomized crossover evaluation of three anesthetic regimens for painful procedures in children with cancer. The Journal of pediatrics. 2013;162(1):137-41.
Parslow R, Morgan AJ, Allen NB, Jorm AF, O'Donnell CP, Purcell R. Effectiveness of complementary and self-help treatments for anxiety in children and adolescents. Med J Aust. 2008;188(6):355-9.
Zeltzer LK, Tsao JC, Stelling C, Powers M, Levy S, Waterhouse M. A phase I study on the feasibility and acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain. J Pain Symptom Manage. 2002;24(4):437-46.
Dufresne A, Dugas M-A, Samson Y, Barré P, Turcot L, Marc I. Do children undergoing cancer procedures under pharmacological sedation still report pain and anxiety? A preliminary study. Pain Med. 2010;11(2):215-23.
Zeltzer L, Altman A, Cohen D, LeBaron S, Munuksela E, Schechter N. Report of the subcommittee on the management of pain associated with procedures in children with cancer. Pediatrics. 1990;86(5):826-31.
Gray A. Book review: Cancer pain relief and palliative care in children WHO Publication, Geneva 1998. Ann Saudi Med. 1999;19(4):388-9.
Coté CJ, Wilson S, Pediatrics AAo, Dentistry AAoP. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118(6):2587-602.
Hertzog JH, Campbell JK, Dalton HJ, Hauser GJ. Propofol anesthesia for invasive procedures in ambulatory and hospitalized children: experience in the pediatric intensive care unit. Pediatrics. 1999;103(3):e30.
Klein SM, Hauser GJ, Anderson BD, Shad AT, Gootenberg JE, Dalton HJ, et al. Comparison of intermittent versus continuous infusion of propofol for elective oncology procedures in children. Pediatr Crit Care Med. 2003;4(1):78-82.
Yazdi AG, Ayatollahi V, Hashemi A, Behdad S, Yazdi EG. Effect of two different concentrations of propofol and ketamine combinations (Ketofol) in pediatric patients under lumbar puncture or bone marrow aspiration. Iran J Ped Hematol Oncol. 2013; 3(1): 187–192.
Hashemi A, Ayatolahi V, Ghilian R, Ghadami YA, Fadavi N, Yadegari Y, et al. Ketofol for bone marrow aspiration and lumbar puncture in Children with ALL. Iranian Journal of Pediatric Hematology & Oncology. 2011;1(4):126-132.
Aouad MT, Moussa AR, Dagher CM, Muwakkit SA, Jabbour-Khoury SI, Zbeidy RA, et al., Addition of ketamine to propofol for initiation of procedural anesthesia in children reduces propofol consumption and preserves hemodynamic stability. Acta Anaesthesiol Scand. 2008; 52(4):561-5.
Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single-syringe ketamine-propofol combination (ketofol). Acad Emerg Med. 2010; 17(2):194-201.
Sajedi P, Habibi B. Comparison of the effects of intravenous premedication: Midazolam, Ketamine, and combination of both on reducing anxiety in pediatric patients before general anesthesia. J Res Pharm Pract. 2015; 4(4):187-92.
Yamauchi M, Asano M, Watanabe M, Iwasaki S, Furuse S, Namiki A. Continuous low-dose ketamine improves the analgesic effects of fentanyl patient-controlled analgesia after cervical spine surgery. Anesth Analg. 2008; 107(3):1041-4.
Yeh CC, Wu CT, Huh BK, Lee MS, Lin SL, J Sheen M, et al. Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough. J Clin Anesth. 2007; 19(1):53-6.
Monsereenusorn C, Rujkijyanont P, Traivaree C. The clinical effect of fentanyl in comparison with ketamine in analgesic effect for oncology procedures in children: a randomized, double-blinded, crossover trial. J Med Assoc Thai. 2015; 98(4):358-64.
Sperring SJ, Sinisi NJ, Robson NJ. Sufentanil plus low-dose ketamine, the ideal induction mixture? Anesth Analg 1988; 67:S215.