Propofol-Ketamine: Safer MRI Sedation for Kids?

TOPLINE:
In children undergoing deep sedation for MRI, a propofol-ketamine combination reduced the incidence of pulmonary atelectasis, offering a more stable cardiovascular profile and faster recovery time than propofol alone, according to a new study.
METHODOLOGY:
Researchers at Samsung Medical Center in Seoul, Korea, compared the incidence of atelectasis after pediatric MRI sedation using a propofol-ketamine combination with that using propofol alone.
Overall, 107 children aged 3-12 years (57.9% boys) with American Society of Anesthesiologists physical status I-II who were undergoing elective 3T MRI under deep sedation were randomly assigned to receive either propofol or the propofol-ketamine combination.
During MRI, patients in the propofol group received 0.2 mL/kg of 1% propofol and 2 mL of 0.9% saline, followed by a continuous infusion of propofol (200 μg/kg/min) and 0.9% saline (0.04 mL/kg/min); patients in the combination group received 0.2 mL/kg of 0.5% propofol and 1 mg/kg of ketamine, followed by a continuous infusion of propofol (100 μg/kg/min) and ketamine (20 μg/kg/min).
The primary outcome was the incidence of lung atelectasis on lung ultrasonography upon arrival at the postanesthesia care unit.
TAKEAWAY:
The incidence of atelectasis was significantly lower in the combination group (58.5%) than in the propofol group (88.9%; relative risk, 0.7; P < .001).
The total lung score was significantly higher in the propofol group than in the combination group (6 vs 2; median difference, 4; P < .001), indicating better pulmonary aeration in patients receiving the propofol-ketamine combination.
The emergence time in the postanesthesia care unit was also shorter with the propofol-ketamine combination than with propofol alone (15 vs 25 minutes; median difference in time, 9 minutes; P < .001).
Hypertension occurred more frequently in the combination group than in the propofol group (34% vs 9.3%; P = .002); however, it was transient, and none of the patients required treatment.
IN PRACTICE:
“Our results suggest that the propofol-ketamine combination may offer potential benefits to vulnerable pediatric patients at increased risk for respiratory complications,” the authors of the study wrote.
SOURCE:
This study was led by Yu Jeong Bang, MD, of the Department of Anesthesiology and Pain Medicine at Samsung Medical Center, Sungkyunkwan University School of Medicine, in Seoul, Korea. It was published online on November 1, 2024, in JAMA Network Open.
LIMITATIONS: 
The generalizability of this study may be limited due to its single-center design and the specific population of Korean children with American Society of Anesthesiologists physical status I-II. The broad age range of participants (3-12 years) encompassed a wide developmental spectrum, which may have affected the consistency of the findings. Baseline lung ultrasonography images were not obtained due to poor cooperation from conscious pediatric patients, limiting the ability to compare lung conditions before and after sedation. Moreover, the study did not evaluate upper airway obstruction, a major cause of atelectasis.
DISCLOSURES:
No funding information was provided for the study. No relevant conflicts of interest were disclosed by the authors.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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