1102

Abstract

Introduction: To examine the comparative dosing, efficacy, and safety of propofol alone or with an initial, sub-dissociative dose of ketamine approach to deep sedation for mild-to-moderately (m/m) painful procedures. Hypothesis: Low-dose ketamine is a more effective drug combination for procedural sedation. Methods: Propofol is a sedative-hypnotic agent used increasingly in children for deep sedation As a non-analgesic agent, its use in m/m painful procedures (like bone marrow biopsies/aspirations, LPs, PICC-line placements or renal or liver biopsies) is debated. Our intensivist-based procedural sedation have as options for m/m painful procedures a propofol-only (P-O) approach or one that includes an age-adjusted dose of 0.25 or 0.5 mg/kg IV ketamine (K+P) prior to propofol. With either approach, an initial induction dose of 1 mg/kg propofol is internally recommended, then intermittent dosing throughout the procedure to achieve adequate sedation to safely and effectively perform the procedure.Retrospective evaluation of 770 patients receiving either the P-O or K+P approach to sedation for m/m procedures. Results: There were 380 patients in the P-O group and, 390 in the K+P group. Mean age (P-O 7.2 ± 5.4y; K+P 7.2 ± 5.4y) and weight (P-O 29.3 ± 23.7kg; K+P 29.7 ± 23.0kg) were similar in both groups (p=NS). All patients successfully completed procedures without complications (i.e hypoxia or hypotension). Procedure time was 16 min longer for K+P group than P-O group (K+P 29.8 ± 29.6; P-O 25.6 ± 26.5; P=.03) yet recovery time 7 min shorter (K+P 28.4 ± 22.8; P-O 35.3 ± 27.5; p=0.0002). Mean total dose of propofol was similar in both groups (K+P 4.0 ± 3.27 mg/kg; P-O 4.39 ± 2.66 mg/kg; p=0.1). Conclusions: Both propfol-only approach and one that includes a single, initial low-dose of IV ketamine appear to be equally effective and safe for mild-to-moderately painful procedures. Ketamine did reduce the recovery time, but, interestingly did not reduce propofol need. Both appear to be viable options depending on patient, staff and physician-specific factors.