TOTAL INTRAVENOUS ANESTHESIA FOR CHILDREN UNDERGOING BRIEF DIAGNOSTICOR THERAPEUTIC PROCEDURES

Study Objective: To compare the quality of anesthesia with propofol, k etamine, or etomidate in children undergoing brief diagnostic or thera peutic procedures. Design: Retrospective study. Setting: University ho spital. Patients: 971 pediatric oncology patients undergoing brief dia gnostic or therapeutic procedures outside the operating room during a one-year period. Interventions: Total intravenous anesthesia was admin istered primarily with ketamine, etomidate, or propofol for oncology-r elated procedures such as bone marrow aspiration, lumbar puncture, rad iologic imaging, and radiation therapy. Quality assurance data were co llected for all patients, including anesthetic technique, dosage, and the occurrence of specific adverse events during anesthesia and recove ry periods. Measurements and Main Results: There were 279 anesthesia-r elated occurrences, comprised almost entirely of five specific events: vomiting, hypoxemia (SpO(2) less than. 94%), tachycardia, agitation, and myoclonus. Ketamine was associated with vomiting (14.6%), agitatio n (15.0%), and tachycardia (19.5%). Etomidate was also associated with vomiting (9.9%) and agitation (1.2%). Hypoxemia was rare except in th e propofol group (15.7%) and was easily managed with supplemental oxyg en, but occasionally required manually assisted ventilation via face m ask. In patients receiving propofol vomiting (0.5%) and agitation (1.2 %) were rare. Conclusions: Anesthesia with propofol, Ketamine, or etom idate is safe and efficacious for children undergoing brief procedures . Propofol is associated with a decreased incidence of postanesthetic agitation and vomiting. Its association with respiratory depression is confirmed.