Total intravenous anesthesia with ketamine for pediatric interventional cardiac procedures

Objective: To evaluate the safety and efficacy of ketamine in pediatric pat ients undergoing interventional cardiac procedures. Design: A retrospective clinical study. Setting: A single, tertiary referral center. Participants: Patients (n = 107) undergoing interventional cardiac procedur es between July 1996 and July 1998, Interventions: Each patient received a bolus of ketamine, 1 mg/kg intraveno usly, followed by an infusion of 50 to 75 mu g/kg/min for the duration of t he procedure. Measurements and Main Results: Hemodynamic and respiratory parameters were noted. All patients were breathing spontaneously. Average infusion dose of ketamine was 51.40 +/- 3.54 mu g/kg/min (mean a standard deviation). Increa ses in heart rate and mean arterial pressure by more than 20% from baseline values were seen in 10 and 9 patients, respectively, Transient apnea and e xcessive salivation were seen in two patients each. Excessive movement of e xtremities was seen in six patients. There were no episodes of unpleasant d reams or hallucinations. There were two deaths (1.9%) related to the interv entional procedures. Conclusion: The technique described is a simple, safe, and effective method for anesthetizing children in the cardiac catheterization laboratory for i nterventional procedures. Copyright (C) 2000 by W.B. Saunders Company.