Propofol-ketamine mixture for anesthesia in pediatric patients undergoing cardiac catheterization

Objective: To evaluate the safety of a propofol-ketamine mixture to induce and maintain anesthesia in spontaneously breathing pediatric patents during cardiac catheterization. Design: Prospective clinical study. Setting: Departments of Cardiothoracic Surgery, Anesthesiology, and Pediatric Anesthesiology in a university hospital. Participants: Forty-five children aged 6 months to 16 years with ASA grade 11 to III undergoing cardiac catheterization. Interventions: Continuous intravenous infusion of a mixture of propofol (4 mg/mL) and ketamine (2 mg/mL) with spontaneous ventilation. The infusion rate was changed and additional boluses of propofol or/and ketamine were given as needed. Hemodynamic, respiratory, and other variables were recorded during the procedure and recovery. Results: Mean dose of ketamine was 26 +/- 8.3 mug/kg/min and of propofol, 68.3 +/- 21.7 mug/kg/min. Changes in heart rate and mean arterial pressure of more than 20% from baseline were observed in 4 and 5 patients, respectively. A transient reduction in oxygen saturation because of hypoventilation was observed in 3 patients and responded to oxygen administration and manual assisted ventilation. No other complications were observed. Conclusions: The propofol-ketamine mixture is a safe, practical alternative for general anesthesia in pediatric patients undergoing cardiac catheterization. (C) 2003 Elsevier Inc. All rights reserved.