Effect of Ketofol Versus Propofol as an Induction Agent on Ease of Laryngeal Mask Airway Insertion Conditions and Hemodynamic Stability in Pediatrics

An Observational Prospective Cohort Study

Bacha Aberra; Adugna Aregawi; Girmay Teklay; Hagos Tasew


BMC Anesthesiol. 2019;19(41) 

In This Article


The most important duty of an anesthetist is the management of airway to deliver sufficient ventilation to the patient by securing airway while general anesthesia is administered. As such, no anesthesia is safe unless meticulous efforts are devoted to maintain an intact and functional airway.[1,2] Effective insertion of the LMA entails optimum anesthetic depth to elude undesirable airway reflexes such as swallowing, gagging, coughing or involuntary movements to severe problems such as laryngospasm.[3,4]

Adequate anesthetic induction situations are paramount delivered by propofol compared to other intravenous induction agents.[4] Nevertheless, when propofol is used as a single induction agent without premedication, doses greater than 3 mg/kg is necessary for smooth LMA insertion.[5,6] On the other hand, increased propofol doses are not required as undesirable cardio-respiratory depression is dose-dependent.[7,8] Several combinations of pharmacological agents have been introduced to decrease the hemodynamic instability in anesthesia.[9,10] Ketamine is well known for its airway reflexes maintaining activity and sympathetic cardiorespiratory stimulant so as to causes little or no cardiorespiratory depression and unlike propofol has pain relieving properties.[11,12]

Hemodynamic stability can be maintained using a combination of ketamine and propofol (ketofol), as there is additive effect of Gamma-aminobutyric acid (GABA) agonism by propofol and N-Methyl-D-Aspartate (NMDA) antagonism by ketamine leading to lesser doses of propofol required along with ketamine.[13] The effectiveness of the two agents, propofol and ketamine, may provide the best induction agent with favorable hemodynamics and decreased side effects attributed to either drug as clinical effects of propofol and ketamine seem to be complementary.[14]

Therefore the finding of this research will help anesthesia professionals to provide safe and effective alternative induction agent for better LMA insertion conditions and improved hemodynamic stability. It also helps health administrators to work on quality improvement, enhancing good patient outcome, supplying cost-effective anesthetic drugs with the better patient outcome and enhancing income generation and cost reduction.