Prevention of emergence agitation in seven children receiving low-dose ketamine and propofol total intravenous anesthesia.

Emergence agitation (EA) can be a distressing side effect of pediatric anesthesia. We retrospectively reviewed the records of 7 pediatric oncology patients who received low-dose ketamine in conjunction with propofol for total intravenous anesthesia (TIVA) repeatedly for radiation therapy. EA signs were observed in all 7 patients in association with propofol TIVA but did not recur in any of 123 subsequent anesthetics sessions during which low-dose ketamine was added to propofol. Based on this experience, we suggest that low-dose ketamine added to propofol may be associated with prevention of EA in children with a history of EA with propofol TIVA.

Safe anesthesia for radiotherapy in pediatric oncology: St. Jude Children's Research Hospital Experience, 2004-2006.

PURPOSE: To determine the incidence of anesthesia-related complications in children undergoing radiotherapy and the associated risk factors. METHODS AND MATERIALS: We retrospectively investigated the incidence and types of anesthesia-related complications and examined their association with age, weight, oncology diagnosis, type of anesthetic (propofol vs. propofol and adjuncts), total propofol dose, anesthetic duration, type of radiotherapy procedure (simulation vs. radiotherapy) and patient position (prone vs. supine). RESULTS: Between July 2004 and June 2006, propofol was used in 3,833 procedures (3,611 radiotherapy sessions and 222 simulations) in 177 patients. Complications occurred during 49 anesthetic sessions (1.3%). On univariate analysis, four factors were significantly associated with the risk of complications: procedure duration (p <0.001), total propofol dose (p <0.001), use of adjunct agents (vs. propofol alone; p = 0.029), and simulation (vs. radiotherapy; p = 0.014). Patient position (prone vs. supine) was not significantly associated with the frequency of complications (odds ratio, 0.71; 95% confidence interval, 0.33-1.53; p = 0.38). On multivariate analysis, the procedure duration (p <0.0001) and total propofol dose (p < or =0.03) were the most significant risk factors after adjustment for age, weight, anesthetic type, and procedure type. We found no evidence of the development of tolerance to propofol. CONCLUSION: The rate of anesthesia-related complications was low (1.3%) in our study. The significant risk factors were procedure duration, total propofol dose, the use of adjunct agents with propofol, and simulation (vs. radiotherapy).