Midazolam, ketamine, or fentanyl added to propofol as total intravenous anesthesia in skin grafting after burn in pediatrics: a comparative study

BackgroundTotal intravenous anesthesia is an alternative to inhalational anesthesia. The combination of two drugs to achieve hypnosis and analgesia is the most common regimen. The combination of propofol and other drugs (midazolam, ketamine, and fentanyl) can be used for induction and maintenance of anesthesia.Aim of the studyThis study aimed to compare the effects of propofol - midazolam, propofol - ketamine, and propofol - fentanyl on intraoperative hemodynamics, recovery, postoperative pain and sedation, and postoperative complications in skin grafting after burn in pediatrics.Patients and methodsNinety pediatric patients (4-11 years' old) scheduled for skin graft after burn (10-20%) were divided into three groups. In group I (the propofol - midazolam group), anesthesia was maintained by an infusion of propofol at a dose of 5 mg/kg/h plus midazolam infusion at a dose of 0.05 mg/kg/h. In group II (propofol - ketamine group), anesthesia was maintained by an infusion of propofol at a dose of 5 mg/kg/h plus ketamine infusion at a dose of 1.5 mg/kg/h. In group III (propofol - fentanyl group), anesthesia was maintained by an infusion of propofol at a dose of 5 mg/kg/h plus fentanyl infusion at a dose of 1 μg/kg/h.ResultsPropofol - ketamine was superior in intraoperative hemodynamic stability. The three groups were comparable in terms of recovery, orientation time, and postoperative complications. Pain and sedation scores were comparable between the three groups in the first postoperative hour, but in the second hour, the propofol - ketamine and the propofol - fentanyl groups showed a significant decrease compared with the propofol - midazolam group.ConclusionPropofol - ketamine showed more hemodynamic stability than the other two groups. The propofol - ketamine and propofol - fentanyl combinations prolonged analgesia and sedation more than propofol - midazolam.