Total intravenous anesthesia with ketamine for pediatric interventional cardiac procedures

Objective: To evaluate the safety and efficacy of ketamine in pediatric patients undergoing interventional cardiac procedures. Design: A retrospective clinical study. Setting: A single, tertiary referral center. Participants: Patients (n = 107) undergoing interventional cardiac procedures between July 1996 and July 1998, Interventions: Each patient received a bolus of ketamine, 1 mg/kg intravenously, followed by an infusion of 50 to 75 mu g/kg/min for the duration of the procedure. Measurements and Main Results: Hemodynamic and respiratory parameters were noted. All patients were breathing spontaneously. Average infusion dose of ketamine was 51.40 +/- 3.54 mu g/kg/min (mean a standard deviation). Increases in heart rate and mean arterial pressure by more than 20% from baseline values were seen in 10 and 9 patients, respectively, Transient apnea and excessive salivation were seen in two patients each. Excessive movement of extremities was seen in six patients. There were no episodes of unpleasant dreams or hallucinations. There were two deaths (1.9%) related to the interventional procedures. Conclusion: The technique described is a simple, safe, and effective method for anesthetizing children in the cardiac catheterization laboratory for interventional procedures. Copyright (C) 2000 by W.B. Saunders Company.