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


In our study, LMA insertion summed score for ketofol and propofol group were nearly similar. This result coincides with the studies done by Goh et al. in their study of randomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on hemodynamics and laryngeal mask airway insertion conditions.[17]

In our study, in ketofol group, we observed a decrease in the requirement of an additional dosage of propofol for induction, although it was not statistically significant (p > 0.05). Consistent with our results, many researchers observed that there was a significant decrease in additional requirement of propofol for induction, loss of consciousness and LMA insertion in ketofol group than propofol group. This less requirement of additional propofol dose is due to the combined effect of ketamine and propofol at both hypnotic and anesthetic endpoints.[2,12,18] However, the reason for the insignificant result in our study might have been due to the use of 3.5 mg/kg (high dose) of propofol for induction unlike Yousef et al..[12] They administered initial 2 mg/kg propofol and incremental doses of propofol until the target level of the Bispectral index of 40 was obtained.

This study also spectacles that, apnea time was significantly longer in propofol group (median = 240 s [range = 60–390 s]) compared with ketofol group (median = 180 s [range = 30–380 s]) (p = 0.005). Consistent with our study[19] in their study of comparison of propofol and ketofol on laryngeal tube-suction II circumstances and hemodynamics showed that apnea duration was longer in group P (median = 385 s [range = 195–840 s]) compared with group KP (median = 325.5 s [range = 60–840 s]) but was not statistically significant.[19] In their study, the overall apnea time was higher than ours. This difference might have been due to the use of remifentanil (1 μg/kg) 60 s after pre-oxygenation because remifentanil is known to have prolonged apnea time than fentanyl.[13]

A comparative study done in Malaysia to compare the effects of ketamine and midazolam as co-induction agents with propofol for proseal™ laryngeal mask airway insertion showed that the ketamine-propofol combination had a shorter duration of apnoea, better mouth opening, and hemodynamic profile as compared to the combination midazolam-propofol.[1]

Another Randomized double-blind comparative study of ketamine-propofol and fentanyl-propofol for LMA insertion in children showed that the conditions of LMA insertion were superior in the combination of ketamine (0.5 mg/kg and propofol than propofol and fentanyl.[20]

Hemodynamic parameters can increase 20% after LMA insertion, with an additional 30% after orotracheal intubation.[1] In our study, we observed that ketofol preserved mean arterial pressure at all measurement times while a significant drop in mean arterial blood pressure was seen in the propofol group. Similarly, several studies concluded that ketofol is superior to propofol and propofol–thiopentone mixture because of its better hemodynamic stability.[11,17,21,22] With the induction of anesthesia, a significant rise in heart rate was observed in ketofol group from baseline while in propofol group, there was a drop in heart rate at all measurement times (P < 0.05). The cardiovascular stimulant effect of ketofol is desirable especially in pediatric anesthesia while the unduly depressant effect of propofol is unwanted.[11,12]


This study was unable to measure anesthetic depth. Therefore the LMA insertion conditions may have been adversely affected and hemodynamic parameters change might be observed. Use of fentanyl in both groups before induction may have affected the hemodynamic effects of the agents.