Department of Pediatric Sciences, Catholic University Medical School, Rome, Italy.
Pediatr Blood Cancer. 2011 Dec 15;57(7):1163-7. doi: 10.1002/pbc.23170. Epub 2011 May 16.
Limited data are available on the best option (short acting sedatives, opioids, or ketamine) in oncologic procedural sedation performed by non-anesthesiologists. The aim of the present prospective study is to compare the safety and efficacy of propofol-ketamine versus propofol alone, managed by trained pediatricians, in children with cancer undergoing painful procedures.
Data on 121 children with acute lymphatic leukemia (ALL) undergoing procedural sedations (lumbar punctures and bone marrow aspirations) were prospectively collected and included drug doses, side effects, pain assessment, and sedation degree. Children were randomly assigned to one of the two groups: P (n = 62) receiving propofol alone and K (n = 59) in whom a ketamine-propofol combination was used.
In group K, the total dose of propofol required was significantly lower than in group P (3.9 ± 3.6 mg/kg vs. 5.1 ± 3.6 mg/kg; P < 0.001). The incidence of hypotension was also significantly lower (11% vs. 39%; P < 0.001). Major O(2) desaturations (defined as SatO(2) < 88%) occurred principally in group P (7 vs. 1; P = 0.05). Both best analgesia and shorter recovery time were obtained with the propofol-ketamine association. No differences were observed in the degree of sedation and in the awakening quality score between the two groups.
The combination of propofol and ketamine produced statistically significant clinical advantages combined with a higher profile of safety in children with cancer undergoing painful procedures.
在非麻醉医师进行的肿瘤介入镇静中，关于最佳选择（短效镇静剂、阿片类药物或氯胺酮）的数据有限。本前瞻性研究的目的是比较在接受痛苦程序的癌症儿童中，由经过培训的儿科医生管理的丙泊酚-氯胺酮与单独使用丙泊酚的安全性和疗效。
前瞻性收集了 121 例急性淋巴细胞白血病（ALL）患儿（行腰椎穿刺和骨髓抽吸术）的镇静数据，包括药物剂量、副作用、疼痛评估和镇静程度。患儿随机分为两组：P 组（n = 62）接受单独使用丙泊酚，K 组（n = 59）接受丙泊酚-氯胺酮联合使用。
在 K 组中，所需的丙泊酚总剂量明显低于 P 组（3.9 ± 3.6 mg/kg 比 5.1 ± 3.6 mg/kg；P < 0.001）。低血压的发生率也明显较低（11%比 39%；P < 0.001）。主要的 O(2) 饱和度下降（定义为 SatO(2) < 88%）主要发生在 P 组（7 例比 1 例；P = 0.05）。丙泊酚-氯胺酮联合使用可获得最佳镇痛效果和更快的恢复时间。两组间镇静程度和苏醒质量评分无差异。
在接受痛苦程序的癌症儿童中，丙泊酚和氯胺酮联合使用具有统计学显著的临床优势，同时具有更高的安全性。
