Effects of Ketamine-Fentanyl and Propofol-Fentanyl Combinations on LMA Insertion Conditions in African Children Undergoing Day-Case Herniotomy

Abstract

Background: Propofol is used as an induction agent to facilitate laryngeal mask airway (LMA) insertion but unwanted responses such as drop in blood pressure, cough, laryngospasm, movement and apnoea may occur. Use of adjuvant with propofol or a combination of different synergistic pharmacologic agents that can maintain airway patency and hemodynamic parameters can be exploited to avoidance these undesirable responses and effects during LMA insertion. We compared the effects of ketaminefentanyl and propofol-fentanyl combinations on LMA insertion conditions and post-operative outcome in children undergoing herniotomy. Methods: The study was randomized double-blinded conducted on eighty ASA physical statuses I and II paediatric patients age ranged 1 to 15 years scheduled for herniotomy. The patients were grouped into two (A and B) of forty patients each and LMA was inserted following administrations of two different drug combinations. Group A received pre-mixed ketamine 2 mg/kg and fentanyl 2 μg/kg while group B received pre-mixed propofol 2.5 mg/kg and fentanyl 2 μg/kg. The quality of response to LMA placement (LMA insertion conditions) and post-operative outcome (patient recovery) was assessed. Results: The number of patients with acceptable LMA insertion conditions were comparable in both groups, p = 1.000, while incidence of apnoea was significantly greater in propofol-fentanyl group, p = 0.045 with no difference in the post-anaesthesia discharge scores between the groups, p = 0.241. Conclusion: Intravenous ketamine-fentanyl combination is a better induction agent for LMA insertion in children with acceptable LMA insertion conditions, good post-operative recovery scores and lower incidence of peri-insertion apnoea when compared with propofol-fentanyl combination.