Propofol for Pediatric Radiotherapy Jyotsna Punj, Sushma Bhatnagar, Abha Saxena, Seema Mishra, T.R. Kannan, Manas Panigrahi and Vipin Pandey Unit of Anesthesiology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. Abstract. Objective : Pediatric radiotherapy is a day care procedure. In children, anaesthesia is necessary to prevent movement during the therapy. Traditionally intramuscular ketamine is used for these procedure because of its inherent safety in a child who used to be left alone in the cobalt room. Methods : This study was designed to explore the efficacy of propofol and ketamine in pediatric radiotherapy in nineteen children. The inclusion criteria was a child fasting for six hours with no fever or URTI in the past week. A child coming to the radiotherapy (RT) unit without an intravenous cannula was given intramuscular ketamine 10 mg/kg and taken for the procedure. Before the child recovered from anaesthesia an intravenous cannula, 20- 22G, Vasofix was inserted for subsequent sittings of RT. The child coming with an intravenous cannula was given propofol 2.5 mg/kg with xylocaine (0.1 mg/kg) without adrenaline. The parameters recorded were pulse rate, oxygen saturation and respiratory rate-baseline to every 30 seconds till five minutes. Onset time, recovery time, oral feeding time and any untoward effects like nausea, vomiting, nystagmus were also noted. Result : The drug was graded on a scale of 0-10 according to parental acceptability where 0 is the worst and 10 is the best acceptability. The mean (• of all the measured parameters were calculated and compared between the two groups. Conclusion : Propofol was associated with faster onset, better recovery, early oral feeding time, no nausea and vomiting and better parental acceptability. There was no hypotension, bradycardia and oxygen saturation at 60 seconds, which was betwen 94-95%, was easily treatable with supplementation of oxygen by face mask, [Indian J Pediatr 2002; 69 (6) : 495-499] Key words : Radiotherapy Drugs; Propofol; Ketamine Radiotherapy in children is usually a short and a day care procedure which is repeated over many days. Nevertheless it requires a still child. As radiotherapy is a day care procedure, an ideal anaesthetic agent should meet the following conditions. 1. Fast onset and pleasant recovery 2. Prevent undesired movements 3. Allows adequate oxygenation and ventilation with spontaneous respiration 4. Should give the anaesthesiologist the ability to titrate and maintain stable drug concentrations 5. Should have minimum side effects such as nausea, pain, sore throat, dysphoria Traditionally intramuscular ketamine has been used for the procedures mainly because of its inherent safety in a child who used to be left alone in the cobalt room. However it is associated with various problems. 1. Repeated injections to the child 2. Prolonged onset and unpleasant recovery 3. Oral secretions 4. Post operative hallucinations 5. Nystagmus, which is a problem in radiotherapy to the eye in retinoblastoma Reprintrequests : Dr. Jyotsna Punj, 41-A, Qutab Enclave,Opp. Qutab Hotel, Phase-I, New-Delhi110016,India. E-mail : jyotsna_punj@yahoo.com 6. Tachyphylaxis, a problem in repeated radiotherapy A study was undertaken in Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India to compare intramuscular ketamine with intravenous propofol for repeated sittings of radiotherapy. MATERIALS AND METHODS After ethics clearance and informed consent from parents, children (1-10 years of age) undergoing radiotherapy were included. We excluded children with history of fever, upper respiratory tract infection within a week, fasting less than 6 hours. A child coming to the radiotherapy (RT) unit without an intravenous cannula was given intramuscular ketamine 10 mg/kg and taken for the procedure. Before the child recovered from anaesthesia an intravenous cannula, 20-22G, Vasofix was inserted for subsequent sittings of RT. The child coming with an intravenous cannula was given propofol 2.5 mg/kg with xylocaine (0.1 mg/kg) without adrenaline. For study purposes Group A included 12 children undergoing 36 sittings with intravenous propofol. Group B included 7 children undergoing 26 sittings with intramuscular ketamine. The number of children in the Indian Journal of Pediatrics, Volume 69--June, 2002 495