Comparison of laryngeal mask airway insertion conditions and hemodynamics among ketamine, fentanyl and normal saline pretreatment for propofol induction in children

Abstract

Introduction: This study was conducted with a double-blind, prospective, randomized, and controlled design, the effects of administering ketamine, fentanyl, and regular saline before propofol induction in children, with focus was on assessing the conditions of laryngeal mask airway (LMA) insertion and the changes in hemodynamics.

Methodology: Sixty children (4 – 14 years) Participants were assigned randomly to one of three groups: ketamine 0.5 mg/kg (n=20), fentanyl 1 μg/kg (n=20), or normal saline (n=20).before induction with propofol 3.0 mg/kg. Heart rate, blood pressure, and SPO2 were noted at baseline, before pretreatment, at LMA insertion, 2 minutes and 4 minutes thereafter. Mouth opening, coughing, swallowing, patient’s movement, laryngospasm, and ease of an insertion were noted.

Results: LMA insertion summed scores, prepared on the basis of these variables, were similar in ketamine (6.75+0.78) and fentanyl (6.10+0.308) group, which were significantly better than saline group (7.80+1.152) (p value <0.05). Mean blood pressure and heart rate were significantly higher in ketamine and normal saline group than fentanyl group. Incidence of apnea (>30 secs) and mean apnea time were significantly higher in fentanyl group (15.20 + 12.36 sec) as compared to ketamine (4.25 + 10.42 sec) (p: 0.004) and normal saline (6.95 + 10.03 sec) (p value: 0.026) groups.

Conclusion: Administering ketamine and fentanyl before using propofol for LMA insertion in children provides equally better LMA insertion condition than placebo and 100% successful first attempt. Ketamine pretreatment is associated with better hemodynamic stability but greater incidence of coughing, while fentanyl pretreatment is associated with greater duration of apnea.