Effectiveness of ketamine and propofol (ketofol)in 1:2 versus 1:3 combinations for Procedural sedation and analgesia in pediatric patients undergoing Bone marrow aspiration and / or Biopsy: A Prospective Cohort Study

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Addis Abeba University


Background: Bone marrow aspiration and Biopsy is a painful procedure done in children with hematologic disorders. The ideal drug administered during this procedure should have sedative and analgesic effect including hemodynamic stability and recovery with minimal side effects. Ketamine and propofol mixture is widely used for its combined effect of amnesia and analgesia as well as heamodynamic stability and decreased post procedural adverse events . This study mainly aims to compare the effectiveness of ketofol in 1:2versus 1:3 combinations for pediatrics undergoing BMA and/or Biopsy . Objectives: The objective of this study was to compare the effectiveness of ketofol in 1:2 versus 1:3 combinations for Procedural sedation and analgesia in children undergoing Bone marrow aspiration and/or Biopsy at Tikur Anbessa Specialized Hospital. Methodology :In this prospective cohort study128 pediatric patients age 1– 12 years undergoing BMA and/or Biopsy with ketofol 1:2 or 1:3 combination at Tikur Anebessa Specialized Hospital from December 2019-March 2020 were included. Hemodynamic and respiratory variables, were noted 1 min before induction (baseline) and every 10 minute until the procedure ends. Ramsay sedation score immediately after induction and every 10 minute during the procedure was recorded. Total sedative and analgesia use was recorded intraoperativley. Post procedural adverse events occurrence was followed in the postoperative period. Normality of the data was checked using Kolmogorov-smirnov test and analyzed using student t test for normally distributed data and chi-square test for categorical data. Non- parametric data was analyzed using Mann –Whitney U test with 95% CI and p- value less than 0.05 is considered as statistically significant. Results: - ketofol 1:2 group ( n=64) compared with ketofol 1:3 group ( n=64) had similar sedation level assessed by RSS , heamodynamic and respiratory outcome, as well as general postoperative adverse events profile, but the total intraoperative analgesia consumption was significantly higher in ketofol 1:3 group (29.7%) when compared to ketofol 1:2 group (7.8%) with p=0.002. Conclusion and recommendation: -Sedation level, general hemodynamic and respiratory profile including post procedural adverse events were comparable between groups. Higher intraoperative analgesia use in ketofol 1:3 group shows the need for additional analgesia in this combination. We recommend ketofol 1:2 combination for pediatrics undergoing BMA and/or Biopsy, due to decreased intraoperative analgesia requirement seen in the group.



Pediatric patients , Bone marrow aspiration ,Biopsy