The Comparison of the Effect of Ketamine-Sufentanil Combination and Propofol-Remifentanil Combination on the Quality of Sedation during Painful Procedures in Children with Hematological Malignancies

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The combinations of sedative and analgesic drugs are used commonly in pediatric patients with hematological malignancies undergoing painful procedures. In this study, we aimed to compare the sedative effect of combinations of ketamine-sufentanil and propofol-remifentanil in pediatric patients with hematologic malignancies undergoing bone marrow aspiration and biopsy.Methods: In this randomized, double-blinded clinical trial study, 82 pediatric patients with hematologic malignancies with indications of painful procedures were enrolled according to inclusion and exclusion criteria. Patients randomly were allocated into two parallel groups. The first group underwent anesthesia with ketamine-sufentanil (sufentanil 0.5 µg/kg, and ketamine 1 mg/kg), and the second group with propofol-remifentanil (propofol 1 mg/kg and remifentanil 1 µg/kg). Hemodynamic features of sedation, as well as side effects, the time of starting the efficacy, and the time of staying in recovery room were compared between the two groups.Findings: There were significant differences between the two groups in movements that needed repeating doses of sedative drugs, pain based on visual analogue scale (VAS), and sedation scale based on the University of Michigan Sedation Scale (UMSS). Besides, there was no significant difference between the two groups according to side effects.Conclusion: Combination of ketamine-sufentanil and propofol-remifentanil are appropriate for sedation in the pediatrics undergoing diagnostic and therapeutic procedures such as bone marrow aspiration, bone marrow biopsy and intraspinal injection; but the combination of ketamine-sufentanil is better than propofol-remifentanil in pain relief, decreasing movements, and the need for repeating doses.

Keywords

References

  1. Bhatnagar S, Mishra S, Gupta M, Srikanti M, Mondol A, Diwedi A. Efficacy and safety of a mixture of ketamine, midazolam and atropine for procedural sedation in paediatric oncology: a randomised study of oral versus intramuscular route. J Paediatr Child Health 2008; 44(4): 201-4.
  2. Jay S, Elliott CH, Fitzgibbons I, Woody P, Siegel S. A comparative study of cognitive behavior therapy versus general anesthesia for painful medical procedures in children. Pain 1995; 62(1): 3-9.
  3. Ghasemi A, Gharavi FM, Sabzevari A. General anesthesia for lumbar puncture and bone marrow aspiration /biopsy in children with cancer. Iran J Ped Hematol Oncol 2013; 3(2): 54-8.
  4. Hockenberry MJ, McCarthy K, Taylor O, Scarberry M, Franklin Q, Louis CU, et al. Managing painful procedures in children with cancer. J Pediatr Hematol Oncol 2011; 33(2): 119-27.
  5. Cechvala MM, Christenson D, Eickhoff JC, Hollman GA. Sedative preference of families for lumbar punctures in children with acute leukemia: propofol alone or propofol and fentanyl. J Pediatr Hematol Oncol 2008; 30(2): 142-7.
  6. Hollman GA, Schultz MM, Eickhoff JC, Christenson DK. Propofol-fentanyl versus propofol alone for lumbar puncture sedation in children with acute hematologic malignancies: propofol dosing and adverse events. Pediatr Crit Care Med 2008; 9(6): 616-22.
  7. Tosun Z, Esmaoglu A, Coruh A. Propofol-ketamine vs propofol-fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes. Paediatr Anaesth 2008; 18(1): 43-7.
  8. Heidari SM, Loghmani P. Assessment of the effects of ketamine-fentanyl combination versus propofol-remifentanil combination for sedation during endoscopic retrograde cholangiopancreatography. J Res Med Sci 2014; 19(9): 860-6.
  9. Seol TK, Lim JK, Yoo EK, Min SW, Kim CS, Hwang JY. Propofol-ketamine or propofol-remifentanil for deep sedation and analgesia in pediatric patients undergoing burn dressing changes: a randomized clinical trial. Paediatr Anaesth 2015; 25(6): 560-6.
  10. Cock C, Doeltgen SH, Omari T, Savilampi J. Effects of remifentanil on esophageal and esophagogastric junction (EGJ) bolus transit in healthy volunteers using novel pressure-flow analysis. Neurogastroenterol Motil 2018; 30(2).
  11. Conway A, Sutherland J. Depth of anaesthesia monitoring during procedural sedation and analgesia: A systematic review and meta-analysis. Int J Nurs Stud 2016; 63: 201-12.
  12. Rudner R, Jalowiecki P, Kawecki P, Gonciarz M, Mularczyk A, Petelenz M. Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy. Gastrointest Endosc 2003; 57(6): 657-63.
  13. Soltesz S, Biedler A, Silomon M, Schopflin I, Molter GP. Recovery after remifentanil and sufentanil for analgesia and sedation of mechanically ventilated patients after trauma or major surgery. Br J Anaesth 2001; 86(6): 763-8.
  14. Jayabose S, Levendoglu-Tugal O, Giamelli J, Grodin W, Cohn M, Sandoval C, et al. Intravenous anesthesia with propofol for painful procedures in children with cancer. J Pediatr Hematol Oncol 2001; 23(5): 290-3.
  15. Battershill AJ, Keating GM. Spotlight on remifentanil: its analgesic and sedative use in the intensive care unit. CNS Drugs 2006; 20(6): 519-22.
  16. Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth 2002; 88(2): 241-5.
  17. Moradi-Farsani D, Naghibi K, Taheri S, Ali-Kiaii B, Rahimi-Varposhti M. Effects of age and gender on acute postoperative pain after cataract surgery under topical anesthesia and sedation. J Isfahan Med Sch 2017; 34(414): 1627-33. [In Persian].
  18. Moradi-Farsani D, Akrami F, Naghibi K, Alikiaii B, Nazemorroaya B. The effect of age and sex on postoperative pain after deep vitrectomy. J Isfahan Med Sch 2017; 34(415): 1660-5. [In Persian].
  19. Naghibi K, Moradi-Farsani D, Hirmandpour A, Forutan A. Comparison of the effect of dexamethasone, acetaminophen, and normal saline on the prevention of headache in patients under elective cesarean section. J Isfahan Med Sch 2017; 35(424): 345-50. [In Persian].
  20. Nazemroaya B, Moradi-Farsani D, Sadeghi-Vaghfi A. Comparison of cisatracurium and succinylcholine on hemodynamic changes during and after electroconvulsive therapy. J Isfahan Med Sch 2016; 34(395): 963-70. [In Persian].
  21. Hayes JA, Lopez AV, Pehora CM, Robertson JM, Abla O, Crawford MW. Coadministration of propofol and remifentanil for lumbar puncture in children: dose-response and an evaluation of two dose combinations. Anesthesiology 2008; 109(4): 613-8.
  22. Berkenbosch JW, Graff GR, Stark JM, Ner Z, Tobias JD. Use of a remifentanil-propofol mixture for pediatric flexible fiberoptic bronchoscopy sedation. Paediatr Anaesth 2004; 14(11): 941-6.
  23. Hungerford JL, O'Brien N, Moore-Clingenpeel M, Sribnick EA, Sargel C, Hall M, et al. Remifentanil for Sedation of Children With Traumatic Brain Injury. J Intensive Care Med 2017; 885066617704390.
  24. Wang HY, Ting CK, Liou JY, Chen KH, Tsou MY, Chang WK. A previously published propofol-remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery. Medicine (Baltimore) 2017; 96(19): e6895.
  25. Sun GQ, Gao BF, Li GJ, Lei YL, Li J. Application of remifentanil for conscious sedation and analgesia in short-term ERCP and EST surgery. Medicine (Baltimore) 2017; 96(16): e6567.
  26. Bairy L, Vanderstichelen M, Jamart J, Collard E. Clonidine or remifentanil for adequate surgical conditions in patients undergoing endoscopic sinus surgery: a randomized study. PeerJ 2017; 5: e3370.
  27. Kramer KJ, Ganzberg S, Prior S, Rashid RG. Comparison of propofol-remifentanil versus propofol-ketamine deep sedation for third molar surgery. Anesth Prog 2012; 59(3): 107-17.
  28. Hooke MC, Grund E, Quammen H, Miller B, McCormick P, Bostrom B. Propofol use in pediatric patients with severe cancer pain at the end of life. J Pediatr Oncol Nurs 2007; 24(1): 29-34.
Journal of Isfahan Medical School
Volume 36, Issue 480 - Serial Number 480
March and April 2018
Pages 548-556

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History

  • Receive Date: 27 November 2017
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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