Effects of low-dose propofol vs ketamine on emergence cough in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anesthesia: a randomized, double-blind, placebo-controlled trial
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Date
2016
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Abstract
Study Objective To determine the effects of low-dose ketamine and propofol on cough during emergence and the recovery period when administered at emergence in children undergoing fiberoptic bronchoscopy for bronchoalveolar lavage (FOBL) with sevoflurane-remifentanil anesthesia. Design Randomized, double-blind, placebo-controlled trial. Setting Operating room, postoperative recovery area. Patients Sixty-eight children aged 1 to 8 years old undergoing elective diagnostic FOBL. Interventions After discontinuation of anesthetics at the end of FOBL, patients were randomly divided into 3 groups: in group K, children were administered 0.5 mg/kg of ketamine; in group P, 0.5 mg/kg of propofol; and in group C, 0.1 mL/kg of normal saline. Measurements Anesthesia time, procedure time, emergence time, and recovery time were recorded. Coughing and delirium scores were recorded as the patient fully emerged from anesthesia (time 0) and 5, 10, 15, and 20 minutes later. Main Results The percentage of children with moderate or severe cough during emergence was similar in all groups. Mean delirium scores at emergence (T0) were significantly lower in group K than those in group P and in group C (P =0001 and P =02). Mean delirium score at 5 minutes in group K (6 [5-10]) was significantly lower than that of group C (P =02) and similar to that of group P. The recovery time of group K was significantly longer than that of group C and group P (P =01 and P =03, respectively). Conclusions Ketamine or propofol given at the end of sevoflurane-remifentanil general anesthesia in children undergoing FOBL did not decrease cough more than normal saline during the emergence period. Ketamine and propofol, compared to normal saline, had a beneficial effect on decreasing the incidence of emergence delirium. Ketamine lengthened recovery time. © 2016 Elsevier Inc.
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Anesthesia Recovery Period , Anesthesia, General , Anesthetics, Inhalation , Anesthetics, Intravenous , Bronchoalveolar Lavage , Bronchoscopy , Child , Child, Preschool , Cough , Double-Blind Method , Emergence Delirium , Female , Humans , Infant , Ketamine , Male , Methyl Ethers , Piperidines , Propofol , Receptors, N-Methyl-D-Aspartate , Time Factors , ketamine , midazolam , mivacurium , oxygen , placebo , propofol , remifentanil , sevoflurane , ether derivative , inhalation anesthetic agent , intravenous anesthetic agent , ketamine , n methyl dextro aspartic acid receptor , piperidine derivative , propofol , remifentanil , sevoflurane , Aldrete score , Article , child , childhood disease , controlled study , coughing , double blind procedure , drug efficacy , face mask , female , fiberoptic bronchoscopy , flexible bronchoscope , flexible bronchoscopy , general anesthesia , human , low drug dose , lung lavage , major clinical study , male , manual ventilation , priority journal , randomized controlled trial , adverse effects , anesthetic recovery , antagonists and inhibitors , bronchoscopy , Cough , Emergence Delirium , general anesthesia , infant , preschool child , time factor