Comparing the Effects of Propofol-Ketamine and Sevoflurane-Ketamine on Emergence Delirium and Pain after General Anesthesia in Pediatric Patients Undergoing Interventional Cardiac Angiography

Abstract

Background: Emergence delirium (ED) is a frequent postoperative complication in children. Its prevalence is about 25-80% and is observed more commonly with rapid-acting volatile anesthetics than the older inhalation agents.
Methods: 30 patients aging between 2 to 8 years were included in this randomized double blind study. We compared the effect of combination of two anesthetic drugs, Propofol-Ketamine and Sevoflurane- Ketamine, on ED and pain after general anesthesia in pediatric patients undergoing interventional cardiac angiography. Agitation was measured by PAED (Pediatric Anesthesia Emergence Delirium) scoring system) and pain by the CHEOPS (Children’s Hospital of Eastern Ontario Scale).
Results: Emergence delirium in 10th minute of recovery was higher in propofol group (7.6±4.47 vs 5.07±3.31, p=0.047) but it was the same between the groups during the rest of recovery times. Pain scores were higher only at the moment of entrance to recovery room in sevoflurane group (6.27±1.99 vs 5.1±1.06, p<0.001). Mean recovery time was shorter in the sevoflurane group than in the propofol group (33.83±15.239 vs 51.67±20.585, p=0.02).  Nausea and vomitting was more frequent in the sevoflurane group (6.6% vs 0%, p, 0.001), which needed no treatment.
Conclusion: There are some minor differences between sevoflurane-ketamine and propofol-ketamine anesthesia. If the length of recovery is not an issue and the patients are not at high risk of nausea and vomiting, either sevoflurane-ketamine combined anesthesia or propofol-ketamine infusion can be suitably used to anesthetise patients for the pediatric cardiac catheterization procedures.