The Comparison of the Effect of Ketamine-Sufentanil Combination and Propofol-Remifentanil Combination on the Quality of Sedation during Painful Procedures in Children with Hematological Malignancies

The combinations of sedative and analgesic drugs are used commonly in pediatric patients with hematological malignancies undergoing painful procedures. In this study, we aimed to compare the sedative effect of combinations of ketamine-sufentanil and propofol-remifentanil in pediatric patients with hematologic malignancies undergoing bone marrow aspiration and biopsy.
In this randomized, double-blinded clinical trial study, 82 pediatric patients with hematologic malignancies with indications of painful procedures were enrolled according to inclusion and exclusion criteria. Patients randomly were allocated into two parallel groups. The first group underwent anesthesia with ketamine-sufentanil (sufentanil 0.5 µg/kg, and ketamine 1 mg/kg), and the second group with propofol-remifentanil (propofol 1 mg/kg and remifentanil 1 µg/kg). Hemodynamic features of sedation, as well as side effects, the time of starting the efficacy, and the time of staying in recovery room were compared between the two groups.
Findings: There were significant differences between the two groups in movements that needed repeating doses of sedative drugs, pain based on visual analogue scale (VAS), and sedation scale based on the University of Michigan Sedation Scale (UMSS). Besides, there was no significant difference between the two groups according to side effects.
Combination of ketamine-sufentanil and propofol-remifentanil are appropriate for sedation in the pediatrics undergoing diagnostic and therapeutic procedures such as bone marrow aspiration, bone marrow biopsy and intraspinal injection; but the combination of ketamine-sufentanil is better than propofol-remifentanil in pain relief, decreasing movements, and the need for repeating doses.