Total intravenous anesthesia for children undergoing brief diagnostic or therapeutic procedures. 1995

R H McDowall, and C S Scher, and S M Barst
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

OBJECTIVE To compare the quality of anesthesia with propofol, ketamine, or etomidate in children undergoing brief diagnostic or therapeutic procedures. METHODS Retrospective study. METHODS University hospital. METHODS 971 pediatric oncology patients undergoing brief diagnostic or therapeutic procedures outside the operating room during a one-year period. METHODS Total intravenous anesthesia was administered primarily with ketamine, etomidate, or propofol for oncology-related procedures such as bone marrow aspiration, lumbar puncture, radiologic imaging, and radiation therapy. Quality assurance data were collected for all patients, including anesthetic technique, dosage, and the occurrence of specific adverse events during anesthesia and recovery periods. RESULTS There were 279 anesthesia-related occurrences, comprised almost entirely of five specific events: vomiting, hypoxemia (SpO2 less than 94%), tachycardia, agitation, and myoclonus. Ketamine was associated with vomiting (14.6%), agitation (15.0%), and tachycardia (19.5%). Etomidate was also associated with vomiting (9.9%) and agitation (1.2%). Hypoxemia was rare except in the propofol group (15.7%) and was easily managed with supplemental oxygen, but occasionally required manually assisted ventilation via face mask. In patients receiving propofol vomiting (0.5%) and agitation (1.2%) were rare. CONCLUSIONS Anesthesia with propofol, ketamine, or etomidate is safe and efficacious for children undergoing brief procedures. Propofol is associated with a decreased incidence of postanesthetic agitation and vomiting. Its association with respiratory depression is confirmed.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007649 Ketamine A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (RECEPTORS, N-METHYL-D-ASPARTATE) and may interact with sigma receptors. 2-(2-Chlorophenyl)-2-(methylamino)cyclohexanone,CI-581,Calipsol,Calypsol,Kalipsol,Ketalar,Ketamine Hydrochloride,Ketanest,Ketaset,CI 581,CI581
D008297 Male Males
D009207 Myoclonus Involuntary shock-like contractions, irregular in rhythm and amplitude, followed by relaxation, of a muscle or a group of muscles. This condition may be a feature of some CENTRAL NERVOUS SYSTEM DISEASES; (e.g., EPILEPSY, MYOCLONIC). Nocturnal myoclonus is the principal feature of the NOCTURNAL MYOCLONUS SYNDROME. (From Adams et al., Principles of Neurology, 6th ed, pp102-3). Myoclonus, Action,Myoclonus, Nocturnal,Myoclonus, Palatal,Polymyoclonus,Myoclonic Jerk,Myoclonic Jerking,Myoclonus Simplex,Myoclonus, Eyelid,Myoclonus, Intention,Myoclonus, Lower Extremity,Myoclonus, Oculopalatal,Myoclonus, Segmental,Myoclonus, Sleep,Myoclonus, Upper Extremity,Action Myoclonus,Extremity Myoclonus, Lower,Extremity Myoclonus, Upper,Eyelid Myoclonus,Intention Myoclonus,Jerk, Myoclonic,Jerking, Myoclonic,Jerks, Myoclonic,Lower Extremity Myoclonus,Myoclonic Jerks,Nocturnal Myoclonus,Oculopalatal Myoclonus,Palatal Myoclonus,Segmental Myoclonus,Simplex, Myoclonus,Sleep Myoclonus,Upper Extremity Myoclonus
D011785 Quality Assurance, Health Care Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Assessment, Health Care,Health Care Quality Assessment,Health Care Quality Assurance,Healthcare Quality Assessment,Healthcare Quality Assurance,Quality Assessment, Healthcare,Quality Assurance, Healthcare,Assessment, Healthcare Quality,Assessments, Healthcare Quality,Assurance, Healthcare Quality,Assurances, Healthcare Quality,Healthcare Quality Assessments,Healthcare Quality Assurances,Quality Assessments, Healthcare,Quality Assurances, Healthcare
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005045 Etomidate Imidazole derivative anesthetic and hypnotic with little effect on blood gases, ventilation, or the cardiovascular system. It has been proposed as an induction anesthetic. Ethomidate,Hypnomidate,R-26490,Radenarkon,R 26490,R26490
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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