Propofol-Ketamine and Propofol-Fentanyl Combinations for Nonanesthetist-Administered Sedation

Objectives: There is a need to compare propofol requirement between propofol-ketamine (PK) and propofol-fentanyl (PF) given as nonanesthetist-administered propofol sedation during pediatric esophagogastroduodenoscopy (EGD). Methods: The study was a parallel-group, randomized, double-blind comparison of the need for additional doses of propofol in the first minute after sedation induction between PK and PF, administered by rotating trainees in pediatrics for sedation during pediatric EGD. A total of 95 children with American Society of Anesthesiologists class I to III between 3 and 12 years undergoing EGD were included and randomized to either of the groups. After midazolam premedication, children received either 0.5 mg/kg ketamine (PK) or 1 mu g/kg of fentanyl (PF) followed by a mandatory 1 mg/kg of propofol. Additional doses of propofol of 0.5 mg/kg each were given to achieve sedation induction (modified Ramsay scale level 6), and further doses were administered during the procedure as required. A total of 92 children (PK, n = 47; PF, n=45) were analyzed. P < 0.05 was considered significant. Results: There was no difference in the propofol dose required for successful scope introduction and also in the need for additional propofol doses and the total additional propofol doses required in the first minute after sedation induction. Propofol injection pain was higher in the PF group (odds ratio 1.78). The adverse events and recovery time were similar. There was no escalation of care, airway intubations, death, or disability. Conclusions: Nonanesthetist-administered propofol sedation is feasible in teaching hospitals. Propofol requirement is similar in both PK and PF combination regimens, but the lower frequency of propofol injection pain may favor the use of PK.