COMPARISON OF KETAMINE-PROPOFOL COMBINATION WITH OR WITHOUT FENTANYL FOR SEDATION IN CHILDREN UNDERGOING INFRAUMBILICAL SURGERIES UNDER SPINAL ANESTHESIA
Authors: Dubey Rohini , Gupta Amita , Chugh Vanya 
Published: February 2024

Background: General anaesthesia has always been the preferred mode of anaesthesia for children. However, paediatric regional anaesthesia has
been gaining popularity over the last few decades. It offers advantages such as rapid onset and recovery, reduced opioid consumption, increased
haemodynamic stability, postoperative pain relief, preservation of airway patency to name a few. Spinal anaesthesia in paediatric patients
invariably requires procedural sedation as children fail to offer cooperation during the procedure. Propofol and ketamine have been used alone and
in combination for procedural sedation. This study was aimed at assessing the safety and efcacy of combination of fentanyl-propofol-ketamine
combination in comparison with combination of propofol ketamine only for procedural sedation in children. To assess intraoperative Objectives:
pediatric sedation state scale, haemodynamic, respiratory parameters and postoperative Modied aldrete score using ketamine and propofol
combination with or without fentanyl for sedation in these children. A Prospective Material and Methods: and Interventional Randomized
Comparative study was conducted at the Department of Anaesthesia And Critical Care, VMMC And Safdarjung hospital, tertiarty care hospital,
India after taking ethical clearance and CTRI registration. A total of 50 children between 3-8 years, ASA I and II, scheduled for short duration
infraumbilical surgeries were included in the study. Patients with any contraindications for neuraxial blockade- spinal deformities, local site
infection, known case of coagulopathy, raised ICP etc,Known allergy to local anaesthetic agents, propofol, Patients with systemic disease,
neurological impairment, airway abnormality, Intercurrent URTI were excluded. All patients received premedication with oral midazolam
0.5mg/kg in 10% dextrose. EMLA cream was applied on site of IV cannulation and skin puncture site of spinal block 45 mins prior to surgery. The
heart rate and oxygen saturation were monitored. Patient was shifted to operation theatre, all standard monitors connected and IV line secured.
Group KPF received bolus of Fentanyl at 2 mcg/kg followed 5 mins later by a bolus of ketamine at 0.2 mg/kg and propofol at 0.8 mg/kg IV which
was followed by infusion of ketamine and propofol at 150 ug/kg/hr and 600 ug/kg/hr. Group KPS received a saline bolus followed 5 mins later by
combination of ketamine and propofol at 0.2 mg/kg and 0.8 mg/kg IV respectively followed by an infusion at 150 ug/kg/hr and 600 ug/kg/hr
respectively. The infusion was titrated to keep the paediatric sedation state score of 2. Haemodynamics and pediatric sedation state score were
monitored at an interval of 5 mins intraoperatively. IV Inj paracetamol 15mg/kg was given at the end of surgery for post op analgesia. Recovery in
the postoperative period was assessed using Modied Aldrete score, patient was followed upto 24 hours for any complications. Statistical analysis
was done using SPSS version 21.0. Group KPF faired signicantly better in comparison to Group KPS in Results: terms of the requirement of
boluses to perform lumbar puncture (p<0.001). 92% patients required only a single bolus dose of ketamine-propofol combination as compared to
KPS group where84% patients did require a second bolus dose of ketamine-propofol combination to perform lumbar puncture. Need of
intraoperative boluses was also signicantly higher in KPS group as compared to KPF group (p = 0.006). The total dose of Propofol required was
1265.52 ±250.22 mcg/kg body weight in KPF group and 1772.16 ±261.51mcg/kg body weight in KPS group (p<0.001). The total dose of
Ketamine was 304.38± 67.16 mcg/kg body weight and 411.04± 97.18mcg/kg body weight in KPF and KPS group respectively (p<0.0001).
Conclusion: Addition of fentanyl to low dose PK combination during spinal anaesthesia in paediatric patients provides better quality of sedation
and quick recovery without any haemodynamic or respiratory compromise.