Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changesa

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Abstract
The aim of this study was to compare propofol-ketamine (PK) and propofol-fentanyl (PF) combinations for deep sedation and analgesia in pediatric burn wound dressing changes. Thirty-two ASA physical status II and III inpatients with a second degree total burn surface area ranging from 5% to 25% were studied in a randomized, double blind fashion. Heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate and Ramsey sedation scores of all patients were recorded perioperatively. Patients were randomly assigned to receive either PK or PF: PK group (n = 17) received 1 mg.kg(-1) ketamine + 1.2 mg.kg(-1) propofol, and PF group (n = 15) received 1 microg.kg(-1) fentanyl + 1.2 mg.kg(-1) propofol for induction. Additional propofol (0.5-1 mg.kg(-1)) was administered when the patients showed discomfort in both groups. If the patient showed discomfort and/or increase in heart rate or systolic arterial pressure, despite additional propofol dose, additional bolus of 0.5-1 mg.kg(-1) ketamine or 0.5-1 microg.kg(-1) fentanyl was administered. There were no significant differences in heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate and sedation scores during the procedure between the groups. Restlessness during the procedure was seen in seven (47%) patients in Group PF and one (5.9%) patient in Group PK (P = 0.013). Both propofol-ketamine and propofol-fentanyl combinations provided effective sedation and analgesia during dressing changes in pediatric burn patients. But propofol-ketamine combination was superior to propofol-fentanyl combination because of more restlessness in patients given propofol-fentanyl.