Effect of different doses of ketamine with low-dose rocuronium on intubation conditions in children: prospective randomized double blind trial.

OBJECTIVE: The effect of ketamine on intubation condition, when used as an induction agent with low-dose rocuronium, is unknown. This study aimed to compare the effects of three doses of ketamine used with 0.3 mg/kg rocuronium and 1 μg/kg fentanyl on intubation conditions in children undergoing short elective surgery. PATIENTS AND METHODS: The study was performed as a prospective, randomized double-blind clinical trial. A total of 60 children aged 2 to 12 years, who were scheduled for inguinal herniorrhaphy under general anesthesia, were randomly allocated into three groups on the basis of ketamine dose: 1 mg/kg (Group K₁, n = 20), 1.5 mg/kg (Group K_1.5, n = 20), and 2 mg/kg (Group K₂, n = 20). The primary outcome was the intubation condition. Other assessments included hemodynamic data, recovery profile, adverse events in the postanesthetic care unit (PACU) and use of fentanyl as a rescue analgesic in the PACU were also assessed. RESULTS: The occurrence of a clinically acceptable intubation condition increased with the use of an increased dose (≥ 1.5 mg/kg) (K₁/K_1.5/K₂: 30%/65%/65%; p=0.038, for trends p=0.028). Hemodynamic data, recovery profile and adverse events in PACU showed no difference among groups. Fentanyl dose used in the PACU was higher in K₁ than K₂ and the number of patients requiring rescue analgesics in the PACU decreased in accordance with the dose of ketamine (K₁/K_1.5/K₂: 30%/15%/0%; p=.031, for trends p=0.013). CONCLUSIONS: Different intubation conditions were observed on the basis of ketamine dose used in conjunction with 0.3 mg/kg rocuronium and fentanyl 1 μg/kg. Ketamine dose ≥ 1.5 mg/kg with low-dose rocuronium should be used to improve intubation conditions in pediatrics. [ABSTRACT FROM AUTHOR]