Ketamine + propofol speeds recovery for peds MRI sedation

(HealthDay)—Use of ketamine at induction followed by reduced propofol infusion rate for maintenance is associated with shorter recovery times for children undergoing magnetic resonance imaging with deep sedation, according to a study published online Jan. 27 in Pediatric Anesthesia.

Achim Schmitz, M.D., from the University Children's Hospital in Zurich, and colleagues randomly assigned 347 children aged 3 months to 10 years scheduled as outpatients for elective magnetic resonance imaging with deep sedation to receive either 1 mg/kg ketamine at induction followed by a propofol infusion rate of 5 mg/kg/hour or a propofol infusion rate of 10 mg/kg/hour without ketamine. The primary outcome was time to full recovery.

The researchers found that the ketamine-propofol group experienced significantly shorter recovery times (38 versus 54 minutes; median difference, 14 minutes; P < 0.001), as well as better quality of induction and higher blood pressure. But, the incidence of movement requiring additional sedative drugs was higher in the ketamine-propofol group. Respiratory side effects, cardiovascular compromise, emergence delirium, and postoperative nausea and vomiting did not differ significantly between the groups.

"Both sedation concepts proved to be reliable with a low incidence of side effects," the authors write. "Ketamine at induction with a reduced propofol infusion rate leads to faster postanesthetic recovery."