Effect of ketamine and sufentanyl on respiratory depression induced by propofol in pediatric patients / 新乡医学院学报

ABSTRACT

Objective To compare the effect of ketamine and sufentanyl on respiratory depression induced by propofol in pediatric patients.Methods Sixty children with taplipes equines in the Department of Pediatric Orthopedics,the Third Affiliated Hospital of Zhengzhou University from February 2014 to August 2015 were selected and divided into ketamine group,sufentanil group and control group,with 20 patients in each group.The patients in ketamine group were given ketamine 1.50 mg· kg-1 by intravenous injection and maintained with ketamine 0.75 mg · kg-1 · h-1 by pump infusion;the patients in sufentanil group were given sufentanil 0.2 μg · kg-1 by intravenous injection and maintained with sufentanil 0.1 μg · kg-1 · h-1 by pump infusion;the patients in control group were given the same volume of saline.The initial plasma concentration of propofol in ketamine group,sufentanil group and control group was 1.1 mg · L-1,and the ratio between the two successive concentration gradients was 1.1.It was defined as positive when patients developed respiration depression.The bispectral index (BIS) and the observer's assessment of alertness/sedation (OAA/S) score of patients in the three groups were recorded at the time point of intravenous infusion ketamine or sufentanil (T1),3 min after propofol target controlled infusion (TCI) (T2),5 min after propofol TCI (T3) and after the target effect-site and plasma concentrations were balanced(T4).The target effect-site concentration was recorded when the BIS dropped to 65 or OAA/S score was 3.The median effective concentration(EC50) and its 95％ confidence interval (CI) of propofol inducing respiratory depression were calculated.Results There was no statistic difference in BIS and OAA/S scores of patients at the time point of T1 among the three group(P ＞ 0.05);the BIS and OAA/S scores of patients in ketamine group and sufentanil group were significantly lower than those in the control group at the time point of T2,T3 and T4 (P ＜ 0.05);the BIS and OAA/S scores of patients in ketamine group were significantly lower than those in the sufentanil group at the time point of T2,T3,T4 (P ＜ 0.05).The EC50 and its 95 ％ CI of respiratory depression induced by propofol in ketamine group,sufentanil group and the control group were 1.75 (1.56-2.34),1.86 (1.47-2.23),2.82 (2.56-3.02) mg · L-1 respectively.The EC50 of patients in ketamine group and sufentanil group was significantly lower than that in control group (P ＜ 0.05),but there was no statistic difference in EC50 of patients between the ketamine group and sufentanil group (P ＞ 0.05).Conclusion Both ketamine and sufentanil can increase the EC50 of respiratory depression induced by propofol in pediatric patients,but the effects of both drugs are the same.Ketamine and sufentanil can reduce the BIS and OAA/S scores of patients,enhance the sedation efficacy of propofol,and the effect of ketamine is better than sufentanil.