Abstract
Objective : Pediatric radiotherapy is a day care procedure. In children, anaesthesia is necessary to prevent movement during the therapy. Traditionally intramuscular ketamine is used for these procedure because of its inherent safety in a child who used to be left alone in the cobalt room.Methods : This study was designed to explore the efficacy of propofol and ketamine in pediatric radiotherapy in nineteen children. The inclusion criteria was a child fasting for six hours with no fever or URTI in the past week. A child coming to the radiotherapy (RT) unit without an intravenous cannula was given intramuscular ketamine 10 mg/kg and taken for the procedure. Before the child recovered from anaesthesia an intravenous cannula, 20–22G, Vasofix was inserted for subsequent sittings of RT. The child coming with an intravenous cannula was given propofol 2.5 mg/kg with xylocaine (0.1 mg/kg) without adrenaline. The parameters recorded were pulse rate, oxygen saturation and respiratory rate-baseline to every 30 seconds till five minutes. Onset time, recovery time, oral feeding time and any untoward effects like nausea, vomiting, nystagmus were also noted.Result: The drug was graded on a scale of 0–10 according to parental acceptability where 0 is the worst and 10 is the best acceptability. The mean (±SD) of all the measured parameters were calculated and compared between the two groups.Conclusion : Propofol was associated with faster onset, better recovery, early oral feeding time, no nausea and vomiting and better parental acceptability. There was no hypotension, bradycardia and oxygen saturation at 60 seconds, which was betwen 94–95%, was easily treatable with supplementation of oxygen by face mask
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References
Dalmer HG, Nunn TJ. Intramuscular ketamine with hyaluronidase. Nineteen daily anaesthetics administered to a child for radiotherapy.Anaesthesia 1977; 32(7): 636–638.
Edge WG, Morgan M. Ketamine and pediatric radiotherapy.Anaesth-Intensive Care 1977; 5(2): 153–156.
Amberg HL, Gordon G. Low dose intramuscular ketamine for pediatric radiotherapy: a case report.Anesth Analg 1976; 55(1) : 92–94.
Bennett JA, Bullimore JA. The use of ketamine hydrochloride anaesthesia for radiotherapy in young children.Br J Anaesth 15(sn2) : 192–-201.
Qureshi FA, Mellis PT, MC Fadden MA. Efficacy of oral ketamine for providing sedation and analgesia to children requiring laceration repair.Pediatr Emerg Care 1995; 11(2): 93–97.
Alderson PJ, Lerman J. Oral premedication for pediatric ambulatory anaesthesia: a comparison of midazolam and ketamine.Can J Anaesth 1994; 41(3): 221–226.
Louon A, Lithander J, Reddy VG, Gupta A. Sedation with nasal ketamine and midazolam for cryotherapy in retinopathy of prematurity.Br J Ophthalmol 1993; 77(8): 529–530.
Louon A, Reddy VG. Nasal midazolam and ketamine for pediatric sedation during computerised tomography.Acta Anaesthesiol Scand 1994; 38(3): 259–261.
Parker RL, Mahan RA, Giugliano D, Parker MM. Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children.Pediatrics 1997; 99(3): 427–431.
Kentrup H, Skopnik H, Menke D, Thon HJ, Matern S, Helmann G. Midazolam and ketamine as premdication in colonoscopies: a pharmacodynamic study.Int J Clin Pharmacol Ther 1994; Feb; 32(2): 82–87.
Albanese J, Arnaud S, Rey M, Thomachol L, Alliez B, Martin C. Ketamine decreases intracranial pressure and electroencephalographic activity in traumatic brain unjury patients during propofol sedation.Anesthesiology 1997 Dec; 87 (6): 1328–1334.
Cotsen MR, Donaldson JS, Uejima T, Morello FP. Efficacy of ketamine hydrochloride sedation in children for interventional radiologie procedures.AJR Am J Roenlgenol 1997; 169(4): 1019–1022.
Casey WF, Price V, Smith HS. Anaesthesia and monitoring for paediatric radiotherapy.J R Soc Med 1986; 79(8): 454–456.
Goodman Gilman Pharmacological Basis of Therapeutics, 9th edn. 327.
Boysen K, Sanchez R, Krintel JJet al. Induction and recovery characteristics of propofol, thiopental and etomidate.Act Anaesthesiol Scand 1989; 33: 689–692.
Korttila K, Ostman PL Faure Eet al. Randomized comparison of outcome after propofol — nitrous oxide versus thiopentone-isoflurane-nitrous oxide anaesthesia in patients undergoing ambulatory surgery.Acta Anaesthesiol Scand 1990; 34:400–403.
Borgeat A, Popovic V, Meier D, Schwander D. Comparison of propofol and thiopental/halothane for short-duration ENT surgical procedures in children.Anaesth Analg 1990; 71: 511–515.
Watcha MF, Simeon RM, White PF, Stevents JL. Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatients.Anaesthesiology 1991; 75: 204–209.
Frank W, Horauf K, Held P, Taeger K. Anaesthesia for magnetic resonance tomography in neonates, infants and young children.Radiology 1997; 37(2): 159–164.
Kessler P, Alemdag Y, Hill M, Dietz S, Vettermann J. Intravenous sedation of spontaneously breathing infants and small children before magnetic resonance tomography. A comparison of propofol and methohexital.Anaesthesist 1996; 45(12): 1158–1166.
Mikhelson VA, Poliaev LUA, Voskerchian AE, Lazarev VV. Use of diprivan in anesthesiology of angiographie studies and X-ray endovascular methods of treatment in children.Anesteziol 1996; (6) : 14–17.
Levati A, Colombo N, Arosio EM, Savoia G, Tommasino C, Scialfa G, Boselli L. Propofol anaesthesia in spontaneously breathing pediatric patients during magnetic resonance imaging.Acta Anaesthesiol Scand 1996; 40(5): 561–565.
Scheiber G, Ribeiro FC, Karpienski H, Strehl K. Deep sedation with propofol in preschool children undergoing radiotion therapy.Pediatr Anaesth 1996; 6(3): 209–213.
Hannallah RS, Baker SB, Casey W, Mc-Gill WA, Broadman LM, Norden JM. Propofol. Effective dose and induction characteristics in unpremedicated children.Anesthesiology 1991; 74: 217–219.
Valtonen M, Lisalo E, Kanto J, Rosenberg P. Propofol as an induction agent in children. Pain on injection and pharmacokinetics.Acta Anaesthesiol Scand 1989; 33:152–155.
Cameron E, Johnston G, Crofts S, Morton NS. The minimum effective dose of lignocaine to prevent injection pain due to propofol in children.Anaesthesia 1992; 47: 604–606.
Bready R, Spear R, Fisher B, DeMars P, Rodarte A, Frankville D. Prpofol infusion. Dose-response for CT scans in children.Anesth Analg 1992; 74: S36.
Zacny JP, Lichtor JL. Subjective and pychomotor effects of subanesthetic doses of propofol in healthy volunteers.Anesthesiology 1992; 76: 696–702.
Randell T. Sedation for bronchofiberoscopy: Comparison between propofol infusion and intravenous boluses of fentanyl and diazepam.Acta Anaesthesiol Scand 1992; 36: 221–225.
Wilson E, Mackenzie N, Grant IS. A comparison of propofol and midazolam by infusion to provide sedation in patients who receive spinal anaesthesia.Anaesthesia 1988; 43(suppl): 91–94.
Mackenzie N, Grant IS. Propofol for intravenous sedation.Anaesthesia 1987; 42: 3–6.
Vandermeersch E, Van Hemelrijck J, Byttebier G, Van Aken H. Pharmacokinetics of propofol during continuous infusion for pediatric anaesthesia.Acta Anaesthesiol Belg 1989; 40:161–165.
Marsh B, White M, Morton N, Kenny GN. Pharmacokinetic model drive infusion of propofol in children.Br J Anaesth 1991; 67:41–48.
Saint Maurice C, Cockshott ID, Douglas EJ, Richard MO, Harmey JL. Pharmacokinetics of propofol in young children after a single dose.Br J Anaesth 1989; 63: 667–670.
Jones RDM, Chan K, Andrew LJ. Pharmacokinetics of propofol in children.Br J Anaesth 1990; 65: 661–667.
Kataria BK, Ved SA, Nicodemus HF, Hoy GR, Lea D, Dubois MJet al. The pharmacokinetics of propofol in children using there different data analysis approaches.Anesthesiology 1994; 80:104–122.
Reber A, Wetzel SG, Schnabel K, Bongartz G, Frei FJ. Effect of combined mouth closure and chin lift on upper airway dimensions during routine magnetic resonance imaging in pediatric patients sedated with propofol.Anesthesiology 1999; 90(6): 1617–1623.
Frankville DD, Spear RM, Dyck JB. The dose of propofol required to prevent children from moving during magnetic resonance imaging.Anaesthesiology 1993; 79: 953–958.
Cullen PM, Turtle M, Prys-Roberts Cet al. Effect of propofol anaesthesia on baroreflex activity in humans.Anesth Analg 1987; 66:1115–1120.
Ebert TJ, Muzi M, Berens Ret al. Sympathetic responses to induction of anesthesia in humans with propofol or etomidate.Anesthesiology 1992; 76: 725–733.
Goodman NW, Black AMS, Carter JA. Some ventilatory effects of propofol as sole anaesthetic agent.Br J Anaesth 1987; 59:1497–1503.
Blouin RT, Seifert HA, Babenco HD, Conard PF, Gross JB. Propofol depresses the hypoxic ventilatory response during conscious sedation and isohypercapnia.Anesthesiology 1993; 79:1177–1182.
McDowall RH, Scher CS, Barst SM. Total intravenous anesthesia for children undergoing brief diagnostic or therapeutic procedures.J Clin Anaesth 1995; 7(4): 273–280.
Doze VA, Shafer A, White PF. Propofol-nitrous oxide versus thiopential-isoflurane-nitrous oxide for general anesthesia.Anesthesiology 1988; 69: 63–71.
Watcha MF, Simeon RM, White PF, Stevens JL. Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatients.Anesthesiology 1991; 75:204–209.
Gunawardene RD, White DC. Propofol and emesis.Anaesthesia 43 (suppl): 1988; 65–67.
Borgeat A, Wilder-Smith OHG, Ritat K, Chappuis P, Forni M. Adjuvant propofol is effective in preventing refractory chemotherapy associated nausea and vomiting (abstract).Anaesthesiology 1992;77: A344.
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Punj, J., Bhatnagar, S., Saxena, A. et al. Propofol for pediatric radiotherapy. Indian J Pediatr 69, 495–499 (2002). https://doi.org/10.1007/BF02722651
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DOI: https://doi.org/10.1007/BF02722651