Evaluation of ketamine versus midazolam as co-induction agents with propofol for laryngeal mask airway insertion in children

Background: The ideal combination of adjuncts with induction agents for Laryngeal mask airway (LMA) insertion is a matter of debate, particularly in children. Objective: To comparatively evaluate LMA insertion using ketamine-propofol versus midazolam-propofol in children. Methods: A total of 60 children of both sexes, aged 2-12 years with grade I and grade II ASA, were included in this study and randomly assigned to three groups (n = 20 each); group P received propofol alone, group PK received ketamine-propofol, and group PM received midazolam-propofol. Hemodynamic parameters, LMA insertion conditions, incidence of injection pain and apnea, recovery time and complications were assessed. Results: Ketamine-propofol group achieved better hemodynamic stability compared to the other two groups. The overall LMA insertion conditions were significantly better in PK and PM groups compared to group P. The incidence of injection pain was significantly lower in PK and PM groups compared to group P (P < 0.001). Apnea occurred in 55% of patients in group P and in 35% of patients in group PM but did not occur in group PK. Total dose of propofol consumed and the number of patients required additional boluses of propofol were significantly higher in group P compared to the other two groups. Recovery time was significantly longer in group PM compared to group PK and group P (PM >PK >P). Conclusion: Both midazolam-propofol and ketamine-propofol provide suitable insertion conditions of LMA in children but, the ketamine-propofol combination was advantageous in maintaining hemodynamic stability, decreasing incidence of apnea and less recovery time.