Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Short painful procedures in pediatric age group like bone marrow aspiration (BMA) and biopsy taking are day case operations which demand rapid recovery and minimal incidence of postoperative complications.
OBJECTIVE:
To compare between intra & postoperative complications & the time of stay in the recovery room for pediatrics undergoing short painful procedures under general anesthesia with either "ketamine and thiopental" or "ketamine alone".
PATIENTS AND METHOD:
THIS IS A PROSPECTIVE RANDOMIZED clinical trial done in Children Welfare Hospital in Medical City, Baghdad, Iraq, from August - November 2010 on 89 children patients who were scheduled for short painful procedures. All patients were allocated randomly into 2 groups: the 1st group (KT) received I.V ketamine 1% (1mg/kg) plus I.V thiopental 1% 3-5 mg/kg (anesthetizing dose) on induction and maintained on intermittent I.V doses of thiopental 1% in case of need. While the 2nd group(K) received I.V ketamine 1% (1.5mg/kg) alone on induction and maintained on intermittent I.V doses of ketamine 1%(0.5mg/kg) in case of need. Any intra or postoperative complications & the duration of recovery for all patients were recorded.
RESULTS:
It was found that the intraoperative complications (temporary & mild decrease in arterial O2 saturation and its associated breath holding, & cough) occurred more in the KT group, while the occurrence of (mild involuntary movements and verbal responses) occurred more frequently in the K group. The postoperative complications (nausea, vomiting, verbal hallucinations and dizziness) occurred only in the K group. The duration of recovery is more prolonged in the (KT) group.
CONCLUSION:
The use of combination of thiopentone and ketamine is associated with more mild and temporary intraoperative decreased arterial oxygen saturation, breath holding, and postoperative cough than using ketamine alone, while the use of ketamine alone is associated with more mild involuntary movements and verbal responses, postoperative nausea &/or vomiting, hallucinations, and dizziness. The duration of recovery is prolonged by the use of thiopental.
KEY WORDS: ketamine, thiopental, TIVA, pediatrics, day case.