Propofol and ketamine are well-established sedation agents that have been utilized extensively by anesthesiologists for decades. Studies show that use of propofol and ketamine, while not without some risk of adverse events, is generally safe for pediatric patients. Researchers have conducted systematic reviews to investigate the safety of these common agents on pediatric patients, and under normal circumstances with experienced providers, propofol and ketamine use is effective and recommended.
A systematic review conducted by Filho et al. analyzed results from 417 publications on propofol safety for pediatric use. The majority of studies included in this systematic review indicated a dosage of 1-2mg/kg for preoperative sedation to facilitate anesthetic induction and intraoperative anesthesia maintenance [1]. All studies concluded that the use of propofol on children is safe and effective for most clinical situations. However, the use of propofol in newborns is not yet widely studied; therefore, in these cases, propofol should be used with caution under the guidance of experts who can skillfully manage airway and cardiopulmonary emergencies. A few studies reported the rare occurrence of propofol infusion syndrome, which can be a potentially fatal condition. Symptoms include fever, hypotension, hepatomegaly, and traumatic brain injury [2]. Although this is extremely rare, providers should still be cognizant of its possibility and implement safety measures to prevent this adverse event from occurring. Another study reaffirms the safety and efficacy of propofol for pediatric patients, but the authors still identified adverse events such as cardiopulmonary depression, hypoventilation, and airway obstruction. They advised diligent monitoring of the child before, during, and after the procedure, including a thorough assessment of blood oxygen saturation, respiratory rate, and heart rate. Similar to the previous study, the authors emphasized the importance of having personnel who can handle cardiopulmonary resuscitation readily available during the child’s procedure [3].
Ketamine also has an excellent safety profile, and its use in children over 12 months old is common. For infants under 12 months, there is some concern of airway complications. In addition, some providers avoid ketamine use for children with upper respiratory tract infection to minimize risk of laryngospasm. Although ketamine is considered very safe, some common, minor adverse events include nausea and vomiting after surgery. Less than 5 percent of patients also experience hallucinations and unpleasant dreams. The study also showed that the combination of ketamine and midazolam resulted in higher efficacy compared to fentanyl and midazolam or propofol and midazolam, so ketamine is also an attractive option when used conjunctively with other anesthetic agents. Ketamine’s overall safety and advantageous features such as preservation of airway reflexes and respiratory function make it preferable to many other sedation agents. Experienced professionals should still monitor the patient’s airway and chest wall motion until the patient is fully awake [4].
Results from individual studies and systematic reviews agree with one another on the general safety and efficacy of both propofol and ketamine use in children. Despite the possibility of certain adverse effects, the advantages of using propofol and ketamine are extensive. When used under the careful supervision of dedicated professionals, the risks of adverse events can be minimized and avoided.
References
1. Filho, E. M., Riechelmann, M. B. (2020). Propofol use in newborns and children: is it safe? A systematic review. Jornal de Pediatria, 96(3), 289-309. https://doi.org/10.1016/j.jped.2019.08.011.
2. Hemphill, S., McMenamin, L., Bellamy, M. C., & Hopkins, P. M. (2019). Propofol infusion syndrome: a structured literature review and analysis of published case reports. British Journal of Anaesthesia, 122(4), 448–459. https://doi.org/10.1016/j.bja.2018.12.025
3. Chang, P., Warren, D., Joubert, G., & Rieder, M. (2003). Use of propofol sedation in the paediatric emergency department. Paediatrics & Child Health, 8(8), 511–512. https://doi.org/10.1093/pch/8.8.511
4. Dolansky G., Shah A., Mosdossy G., Rieder M. (2008). What is the evidence for the safety and efficacy of using ketamine in children?. Paediatr Child Health, 13(4), 307-308. https://doi.org/10.1093/pch/13.4.307
