Effects of addition of ketamine, fentanyl and saline with propofol induction on hemodynamics and laryngeal mask airway insertion conditions in oral clonidine premedicated children

ABSTRACT

The aim of this double-blind, prospective, randomized, controlled study was to compare the effect of addition of ketamine; fentanyl and saline with propofol anesthesia on hemodynamic profile and laryngeal mask airway [LMA] insertion conditions in oral clonidine premedicated children. 180 children [age 2 - 10 years] were at first given oral clonidine [4 microg/kg] 90 minutes before operation, and then were randomly allocated to receive either ketamine 0.5 mg/kg [n=60], fentanyl 1 micro g/kg [n=60] or 0.9% normal saline [n=60] before induction with propofol 3.0 mg/kg. Insertion of LMA was performed within 1 minute of injection of propofol. Heart rate and mean blood pressure were noted 1 min before induction [baseline], immediately after induction, before and after insertion of LMA for up to 3 min. Following LMA insertion, 6 subjective end points were noted-mouth opening, coughing, swallowing, patient's movement, laryngospasm, and ease of an insertion. LMA insertion summed score was prepared depending upon these variables. LMA insertion summed score was nearly similar in ketamine and fentanyl group, which were significantly better than saline group [P<0.004]. Mean blood pressure and heart rate were maintained in ketamine than with fentanyl or saline group. Incidence of prolonged apnea [>120 secs.] was higher in fentanyl group compared to ketamine and saline group. Even in oral clonidine premedicated children, addition of ketamine with propofol provides hemodynamic stability and comparable conditions for LMA insertion like fentanyl propofol with significantly less prolonged apnea