Chiaretti A et al. (2014)3333 Chiaretti A, Benini F, Pierri F, Vecchiato K, Ronfani L, Agosto C, et al. Safety and efficacy of Propofol administered by paediatricians during procedural sedation in children. Acta Paediatr. 2014;103:182-7.
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36516 sedations in children between 1 month and 10 years of age |
Retrospective cohort |
1-2 mg/kg depending on age and procedure |
- Mean induction time was 3 min. |
II |
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- Mean wake-up time was 13 min. |
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Proportion of adverse events: |
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-0.05% - hypotension requiring intervention |
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-0.4% - PAP |
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-0.04-0.2 % - laryngeal or bronchospasm |
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Koriyama H et al. (2014)3434 Koriyama H, Duff JP, Guerra GG, Chan AW. Sedation withdrawal and analgesia team. Is propofol a friend or a foe of the pediatric intensivist? Description of propofol use in a PICU. Pediatr Crit Care Med. 2014;15:e66-71.
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210 children between 1 month and 17 years old (mean age 1.2 years) |
Retrospective cohort |
Safety and efficacy evaluation of propofol in pediatric ICU, continuous infusion up to 0.4 mg/kg/hour |
- Minimum and maximum infusion rates (including bolus doses) were 0.5 and 7.8 mg/kg/h, respectively. |
II |
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- There was no mortality or occurrence of propofol infusion syndrome (PIS) |
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Costi D et al. (2015)3535 Costi D, Ellwood J, Wallace A, Ahmed S, Waring L, Cyna A. Transition to propofol after sevoflurane anesthesia to prevent emergence agitation: a randomized controlled trial. Paediatr Anaesth. 2015;25:517-23.
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230 children aged 1-12 years (mean age of control group: 4.1 years; propofol: 4.0 years) |
Randomized clinical trial |
3 mg/kg propofol vs. midazolam (up to 15 mg) to compare proportion of postoperative emergency agitation (EA) |
The incidence of EA was lower in the propofol group at different scales (29-39 % vs. 7-15%; RR = 0.25; 95% CI: 0.12-0.62; p < 0.001) |
I |
Zhang JM et al. (2015)3636 Zhang F, Wang Z, Xin TT, Zi HLV. Treatment of different-aged children under bispectral index monitoring with intravenous anesthesia with propofol and remifentanil. Eur Rev Med Pharmacol Sci. 2015;19:64-9.
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40 ASA I-II children aged 2 months to 12 years old |
Case series, without randomization or control group |
- Induction with 3 mg/kg of propofol and maintenance with 6 mg/kg/h associated with remifentanil (loading dose: 1 mcg/kg; maintenance dose: 0.25 mcg/kg/min) |
- From anesthetic induction to awakening, there were no clinically relevant adverse events. |
V |
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- Each group (four groups according to age range) was evaluated from the preoperative period to awakening at the same doses as above. |
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Jager MD et al. (2015)3737 Jager MD, Aldag JC, Deshpande GG. A presedation fluid bolus does not decrease the incidence of propofol-induced hypotension in pediatric patients. Hosp Pediatr. 2015:85-91.
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126 children (6-60 months) |
Prospective, randomized, controlled, non-blinded study |
- 1-6 mg/kg with or without previous SF infusion, 20 mL/kg for MRI sedation or auditory evoked potential assessment |
- Hypotension was detected in 26 patients, with no difference between the two groups of patients who received or not SF (p = 0.26). |
II |
Kang J et al. (2017)3838 Kang R, Shin YH, Gil NS, Kim KY, Yeo H, Jeong JS. A comparison of the use of propofol alone and propofol with midazolam for pediatric magnetic resonance imaging sedation - a retrospective cohort study. BMC Anesthesiol. 2017;17:138.
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20 children aged 3-7 years (mean age 5.0 ± 1.45) |
Prospective cohort |
- Preoperative administration of 1 mg/kg midazolam IV; propofol-induced anesthesia (2 mg/kg) to assess pulse transit time (PTT) or time of propofol distribution according to changes in vascular tone |
- PTT increased after propofol injection and peaked approximately 17 minutes after measurement (166.2 ± 25.9 vs. 315.9 ± 64.9 ms). This shows that propofol administration affected vascular tone. |
III |
Scheier E et al. (2015)3939 Scheier E, Gadot C, Leiba R, Shavit I. Sedation with the combination of ketamine and propofol in a pediatric ED: a retrospective case series analysis. Am J Emerg Med. 2015;33:815-7.
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429 children (median age of 6.8 years) |
Retrospective cohort |
- Propofol 1 mg/kg + ketamine 1 mg/kg in emergency room procedures |
- 52 procedures (12.1 %) showed adverse events, including 39 hypoxic events (9.1 %), 12 apneic events (2.8 %), and one case of laryngospasm (0.2 %). |
II |
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- The increase in ketamine or propofol doses did not change adverse events (p = 0.63; 95 %CI 0.52-2.97) |
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Louvet N et al. (2016)4040 Louvet N, Rigouzzo A, Sabourdin N, Constant I. Bispectral index under propofol anesthesia in children: a comparative randomized study between TIVA and TCI. Paediatr Anaesth. 2016;26:899-908.
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62 children aged 4-14 years |
Randomized clinical trial |
-1 mg/kg in the induction, and 1 mg/kg/h in the maintenance, comparing different methods to identify the best BIS-guided plasma propofol concentration |
- Propofol administration not using TCI, guided by clinical signs, is associated with a higher risk of overdose compared to BIS-guided administration; there was no great difference between TIVA and TCI (higher mean dose from 31% to 59% of cases). |
I |
Watt S et al. (2016)4141 Watt S, Sabouri S, Hegazy R, Gupta P, Heard C. Does dexmedetomidine cause less airway collapse than propofol when used for deep sedation?. J Clin Anesth. 2016;35:259-67.
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40 children aged 3-7 years; mean age in propofol group: 5.1 years) |
Randomized clinical trial |
-3 mg/kg/h in continuous infusion during MRI vs. group receiving 1 mcg/kg/h dexmedetomidine to compare airway patency |
- HR, SBP and PaCO2 (the latter after the procedure) did not differ between the two groups (p < 0.013 for each univariate analysis). |
II |
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- There was no difference regarding the degree of airway collapse between the two groups in sagittal or axial views. |
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Ozturk T et al. (2016)4242 Ozturk T, Acikel A, Yilmaz O, Topcu I, Cevikkalp E, Yuksel H. 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. J Clin Anesth. 2016;35:90-5.
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68 children aged 1-8 years old (mean age of 3 years in the propofol group) |
Randomized, double blind controlled trial |
- Group C (0.5 mg / kg ketamine); Group P (0.5 mg/kg propofol) and Group S (SF 0.1 mL/kg) to evaluate cough and emergency agitation (EA)after sevoflurane administration in children undergoing bronchoscopy) |
- The percentage of children with moderate or severe cough during emergency was similar in all groups. |
II |
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- The mean delirium scores at the emergency were significantly lower in group K than in group P and group S (p = 0.0001) |
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Sriganesh K et al. (2017)4343 Sriganesh K, Saini J, Theerth K, Venkataramaiah S. Airway dimensions in children with neurological disabilities during dexmedetomidine and propofol sedation for magnetic resonance imaging study. Turk J Anaesthesiol Reanim. 2018;46:214-21.
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72 children aged 1-6 years (mean age of propofol group (3.2 years) |
Non-blinded, randomized trial |
- To evaluate airway dimensions during sedation with propofol and dexmedetomidine in children undergoing MRI with neurological impairment (respective doses 2 mg/kg and 2 mcg/kg/min) |
There was no significant difference in airway dimensions between the dexmedetomidine and propofol groups. |
II |
- Airway complications were less frequent and sedation quality was better with dexmedetomidine in children with neurological impairment. |
Jain A et al. (2017)4444 Jain A, Gombar S, Ahuja V. Recovery profile after general anaesthesia in paediatric ambulatory surgeries: desflurane versus propofol. Turk J Anaesthesiol Reanim. 2017;46:21-7.
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80 children (3-10 years; propofol group: 39 patients) |
Randomized controlled trial without blinding |
- To compare the recovery profile in pediatric outpatients submitted to general anesthesia using desflurane (2-8%) and propofol (100-150 mcg/kg/min) as maintenance anesthetics. |
- Desflurane and propofol provided similar recovery profiles in ASA I and II children. |
II |
- Difference in HR in the propofol group was statistically significant during most of the surgical time (p = 0-0.02). |
- Awakening and hospital release time and respiratory events were statistically equal in both groups (p = 0.12). |
Bhatt M et al. (2017)4545 Bhatt M, Johnson DW, Chan J, Taljaard M, Barrowman N, Farion KJ, et al. Risk factors for adverse events in emergency department procedural sedation for children. JAMA Pediatr. 2017;171:957-64.
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6,295 children <18 years old (mean age of 8 years) |
Prospective, multicenter, observational cohort study |
- 1.5-3.2 mg/kg propofol vs. ketamine 0.9-1.5 mg/kg vs. fentanyl 1 mcg/kg, comparing AEs in children undergoing various procedures outside the operating room |
- Adverse events occurred in 736 patients (11.7 %). Oxygen desaturation (353 patients) and vomiting were the most common of these adverse events. |
I |
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- There were 69 severe adverse events (SAEs) (1.1 %) and 86 patients (1.4 %) required intervention. |
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- SAEs - OR for propofol 5,6; OR for ketamine and fentanyl 6.5, both with p < 0.05 |
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Indra S et al. (2017)4646 Indra S, Haddad H, OʼRiordan MA. Short-term Propofol infusion and associated effects on serum lactate in pediatric patients. Pediatr Emerg Care. 2017;33:e118-21.
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50 children (2-18 years; mean age of 9 years) |
Prospective longitudinal study |
2 mg/kg (1-9 mg/kg) to evaluate whether sedation of short-term procedures in children with propofol is related to propofol infusion syndrome (PIS) measured by serum lactate. |
- The mean propofol dose per patient was 8.2 mg/kg |
II |
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- The highest measured lactate value was 1.8 mmol/L. Mean pre- and post-procedure lactate values were 1.0 (0.3) and 0.7 (0.2) (p < 0.001). |
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Karacaer et al. (2018)4747 Karacaer F, Biricik E, Inginel M, Küçükbingöz Ç, Ağın M, Tümgör G, et al. Remifentanil-ketamine vs. propofol-ketamine for sedation in pediatric patients undergoing colonoscopy: a randomized clinical trial. Rev Bras Anestesiol. 2018;68:597-604.
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70 children (2-16 years) |
Randomized clinical trial in colonoscopy patients |
Comparison between ketamine + remifentanil (2 mg/kg and 0.25 mcg/kg respectively) and propofol + ketamine (1 mg/kg and 2 mg/kg) |
- Better intraoperative sedation and less need for rescue analgesia in the K + P group |
II |
Kang P et al. (2018)4848 Kang P, Jang YE, Kim EH, Lee JH, Kim JT, Kim HS. Safety and efficacy of propofol anesthesia for pediatric target-controlled infusion in children below 3 years of age: a retrospective observational study. Expert Opin Drug Saf. 2018;17:983-9.
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218 patients younger than 3 years (109 patients in the propofol group and 109 in the control group) |
Retrospective study |
- To assess the safety and efficacy of propofol for anesthesia maintenance using controlled infusion compared to inhalation anesthesia by evaluating clinical data of patients under 3 years of age. |
- Difference in the proportion of patients who had decreased SBP (p < 0.001) and HR (p = 0.03) under propofol use, but there was no difference in DBP (p = 0.238) or MBP (p = 0.175) during surgery. |
II |
Narula et al. (2018)4949 Narula N, Masood S, Shojaee S, McGuinness B, Sabeti S, Buchan A. Safety of propofol versus nonpropofol-based sedation in children undergoing gastrointestinal endoscopy: a systematic review and meta-analysis. Gastroenterol Res Pract. 2018:6501215.
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5 months to 18 years |
Systematic review and meta-analysis of 625 articles |
- The aim of this study was to evaluate and compare the safety of sedation with propofol alone (0.5-3 mg/kg) for gastrointestinal endoscopy procedures with other anesthetic regimens in the pediatric population. |
Subgroup analysis was not statistically significant between cardiovascular and respiratory complications. (total odds ratio: 1.31; 95 %CI: 0.57-3.04, p = 0.08) |
I |
Kang R et al. (2018)5050 Kang R, Shin BS, Shin YH, Gil NS, Oh YN, Jeong JS. Incidence of tolerance in children undergoing repeated administration of propofol for proton radiation therapy: a retrospective study. BMC Anesthesiol. 2018;18:125.
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58 children (mean of 4.5 years) |
Retrospective cohort |
Induction with 2 mg/kg followed by continuous infusion of 250 mcg/kg/min) to assess the development of tolerance to propofol used for repeated deep sedation in children undergoing proton radiation therapy (PRT). |
-74% of patients did not develop tolerance after repeated propofol sedation during weeks |
III |
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- There were no significant differences between children who developed tolerance and children who did not develop tolerance regarding the mean propofol dose and awakening time over time (p = 0.887 and p = 0.652, respectively). |
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Kara D et al. (2018)5151 Kara D, Bayrak NA, Volkan B, Uçar C, Cevizci MN, Yılmaz S. Anxiety and salivary cortisol levels in children undergoing esophago-gastro-duodenoscopy under sedation. J Pediatr Gastroenterol Nutr. 2018;68:3-6.
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Children aged 5-18 years (119 in propofol group) |
Prospective, multicenter study |
Initial propofol dose of 2 mg/kg and additional 0.5 mg/kg every 3-5 min to measure salivary cortisol level (SCL) and anxiety level in patients submitted to EGD |
Post-EGD SCL was higher than baseline (p = 0.03). Patient anxiety levels were positively correlated with propofol dose by weight, propofol dose per minute and duration of sedation and recovery and negatively correlated with age. |
I |
Biricik E et al. (2018)5252 Biricik E, Karacaer F, Güleç E, Sürmelioğlu Ö, Ilgınel M, Özcengiz D. Comparison of TIVA with different combinations of ketamine-propofol mixtures in pediatric patients. J Anesth. 2018;32:104-11.
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75 children aged 3-12 years old |
Randomized, prospective, double blind study |
-Evaluate the effect of TIVA with different proportions of ketofol (ketamine-propofol) on the children's recovery. Ratios of 1:5, 1:6.7 and 1:10 mg/kg ketamine-propofol were prepared in the same syringe for groups I, II, and III, respectively. |
- Extubation time was significantly shorter in group 1: 5 (mean 254.3 ± 92.7 sec. [p = 0.001]) in group I than in groups II and III (371.3 ± 153 sec. and 343.2 ± 123.7 sec, respectively) |
II |
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- Length of stay in the SRPA was shorter in group I [median 15 min (p = 0.001)] than in groups I and II: 20 min in both. |
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Hayes J et al. (2018)5353 Hayes J, Matava C, Pehora C, El-Beheiry H, Jarvis S, Finkelstein Y. Determination of the median effective dose of Propofol in combination with different doses of ketamine during gastro-duodenoscopy in children: a randomised controlled trial. Br J Anaesth. 2018;121:453-61.
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56 children aged 3-12 years old |
Randomized clinical trial |
Combination of 3 propofol doses (0.25, 0.5 and 1 mg/kg) associated with ketamine to assess adequate anesthesia level during endoscopy |
The use of an adjuvant to propofol sedation at a dose of 1 mg/kg when compared to the groups was significantly lower (p < 0.008). |
II |
Kocaturk et al. (2018)5454 Kocaturk O, Keles S. Recovery characteristics of total intravenous anesthesia with propofol versus sevoflurane anesthesia: a prospective randomized clinical trial. J Pain Res. 2018;11:1289-95.
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120 children (3-6 years old, with a mean age of 4.67 years in the propofol group) |
Randomized clinical trial |
Two groups - induction with nitrous oxide and remifentanil 1.5 mcg/kg + maintenance with sevoflurane; another group induced with propofol 2.5 mg/kg and maintained with propofol (TIVA) during dental surgical procedures |
- The incidence of AEs was higher after sevoflurane than after TIVA (65.5 vs. 3.4 %, p = 0.00). |
I |
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- Higher postoperative pain was observed in the SEVO group (median FLACC score 3 vs. 1, p = 0.000). |
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- A higher level of parental satisfaction was observed in the TIVA group. |
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Karanth et al. (2018)5555 Karanth H, Raveendra US, Shetty RB, Shetty P, Thalanjeri P. Comparative evaluation between sevoflurane and propofol for endotracheal intubation without muscle relaxants in pediatric cleft surgeries. Anesth Essays Res. 2018;12:434-9.
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80 children (1-10 years; men age in the propofol group: 5.5 years) |
Randomized clinical trial |
3 mg/g vs. sevoflurane 8% in anesthetic induction to compare the proportion of orotracheal intubations (OTI) without neuromuscular blockers in palatoplasty |
- Better OTI conditions in the sevoflurane group: less coughing and movement and lower OTI facility scores (p < 0.002) |
II |
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- No difference in BP, HR, or RR alterations |
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Koch S et al. (2018)5656 Koch S, Rupp L, Prager C, Mörgeli R, Kramer S, Wernecke KD, et al. Incidence of epileptiform discharges in children during induction of anaesthesia using propofol versus sevoflurane. Clin neurophysiol. 2018;129:1642-8.
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57 children aged 0.5-8 years (mean age in the propofol group - 57.6 months) |
Observational prospective cohort |
Induction with propofol 6 mg/kg or sevoflurane 6 % for later comparison in EEG tracing during surgical procedures |
Epileptiform discharges were observed in 36 % of children in the propofol group, compared to 67 % in the sevoflurane group (p = 0.03). |
II |
Nagoshi M et al. (2018)5959 Nagoshi M, Reddy S, Bell M, Cresencia A, Margolis R, Wetzel R, et al. Low-dose dexmedetomidine as an adjuvant to propofol infusion for children in MRI: a double-cohort study. Paediatr Anaesth. 2018;28:639-46.
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306 children (1 month to 20 years; 74 children in the propofol group) |
Retrospective cohort |
Three groups - propofol only (P) 3.1 mg/kg; dexmedetomidine only (D) 0.5 mcg/kg; or both (PD) during MRI scans |
- Total propofol dose was higher in group P compared to P + D (182 vs. 147 mcg/kg/min; p < 0.001) |
II |
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- Significantly lower MBP in group P compared to P + D (p = 0.004) |
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- Transient saturation drop was more frequent in group B, without statistical significance (p = 0.174). |
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- Mean sedation depth was greater in group A (modified Ramsay 4.89 vs. 4.1; p < 0.001) |
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- Emergency symptoms were more commonly observed in group A (38 vs. 7 times; p < 0.001). |
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- Sedation failure: nine cases, only in group B (p = 0.002) |
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Ramgolam A et al. (2018)5757 Ramgolam A, Hall GL, Zhang G, Hegarty M, Ungern-Sternberg BS. Inhalational versus intravenous induction of anesthesia in children with a high risk of perioperative respiratory adverse events: a randomized controlled trial. Anesthesiology. 2018;128:1065-74.
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300 children up to 8 years (mean age in the propofol group: 4.5 years) |
Randomized clinical trial |
Comparison between 8 % sevoflurane and 55 % N2O in O2 for 20-30 sec or propofol 3-5 mg/kg for assessment of perioperative respiratory adverse events |
Best results in the propofol group (perioperative respiratory adverse events: 39/149 [26%] vs. 64/149 [43%], [RR]: 1.7; 95%CI: 1.2-2.3; p = 0.002; respiratory adverse events on induction:16/149 [11%] vs. 47/149 [32%], RR: 3.06; 95% CI: 1.8 - 5.2, p < 0.001) |
I |
Schmitz A et al. (2018)5858 Schmitz A, Weiss M, Kellenberger C, O'Gorman Tuura R, Klaghofer R, Scheer I, et al. Sedation for magnetic resonance imaging using propofol with or without ketamine at induction in pediatrics-a prospective randomized double-blinded study. Paediatr Anaesth. 2018;28:264-74.
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347 children (aged 1 month to 11 years) |
Randomized double blind clinical trial |
Group 1: 1 mg/kg of ketamine and 5 mg/kg/h of propofol; group 2 received only propofol 10 mg/kg/h for sedation for elective MRI |
- Recovery time in group 1 was significantly shorter:38 (22-65) minutes compared to 54 (37-77) minutes in group 2 (difference between medians of 14 minutes (95 % CI: 8-20 min; p < 0.001) |
II |
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- Group 2 presented higher AEs |
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- No significant adverse events in either group. |
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