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

Abstract Background Bone marrow aspiration (BMA) and Biopsy is a painful procedure done in children with hematologic disorders. Ketamine and Propofol mixture is widely used for its combined effect of amnesia and analgesia as well as hemodynamic stability and decreased post procedural adverse events. Smooth analgesia and anesthesia is mandatory in such like pediatrics procedures. Objective 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 Biopsy at Tikur Anbessa Specialized Hospital from December 2019-March 2020. Methods This prospective cohort study recruits 128 American Society of Anesthesiologist class I and II, pediatric patients age between 1– 12 years undergoing for BMA and Biopsy with ketofol 1:2 or 1:3 combination were included. Hemodynamic, respiratory and RSS (Ramsay sedation score) variables were noted and recorded every 10 minute during the procedure. 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, hemodynamic 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 Ketofol 1:3 group shows the need for additional analgesia in this combination. Whereas ketofol 1:2 combination for pediatrics undergoing BMA and Biopsy has decreased intraoperative analgesia requirement.