The use of ketofol for procedural sedation in paediatric bone marrow aspiration and intrathecal chemotherapy in children

Abstract

Background: Procedural sedation is an effective component of care in paediatric oncology for painful diagnostic and therapeutic procedures. The aim of this study was to evaluate the safety and efficacy of ketamine/propofol combination in procedural sedation for the bone marrow biopsy and intrathecal chemotherapy in paediatricpatients in the paediatric oncology ward.
Methods: Fourteen paediatric oncology patients at the Paediatric oncology ward of the Lagos University Teaching Hospital, Idi- Araba, Lagos who were to have bone marrow biopsy and intrathecal chemotherapy and were in need for proceduralsedation were included in this study. An initial bolus dose (500 mcg/kg) of ketamine/propofol1:1 (ketamine 8 mg/ml and propofol 8 mg/ml) was given to all patients followed by top up at a dose of 10 mcg/kg to achieve Ramsay Sedation Scale of 4.
Results: The mean age of the patients was 6±2 years. The median initial bolus dose of ketofol administered was 5 ml of aliquot with median dosage of 6 ml (range: 4.8–7.5 ml) only three patients (21.4%) needed the dose to be increased to achieve Ramsay score 4. Only one patient experienced hypotension due to hypovolemia secondary to persistent vomiting prior to procedure
Conclusion: Intravenous administration of ketofol may provide adequate and safe procedural sedation for oncology patients in the paediatric oncology ward, with rapid recovery and no clinically significant complications. Further studies with larger number of patients are required to evaluate and validate these findings.

Keywords: Ketamine, propofol, procedural sedation, bone marrow, biopsy.