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Abstract
Background:
Pediatric anesthesia requires careful selection of anesthetic agents to ensure adequate anesthesia while maintaining cardiovascular and respiratory stability. Propofol is widely used because of its rapid onset and short recovery time; however, it may cause hypotension and respiratory depression. Ketamine provides effective analgesia and generally maintains cardiovascular stability and airway reflexes, although it may be associated with adverse effects such as emergence reactions, hallucinations, and delirium. Despite their frequent use in pediatric anesthesia, direct comparisons of the hemodynamic and respiratory effects of propofol and ketamine remain limited.
Objective:
The aim of this study was to compare the effects of propofol and ketamine in pediatric patients undergoing elective surgery under general anesthesia, with particular emphasis on changes in blood pressure, heart rate, and respiratory depression.
Methodology:
A comparative observational cross-sectional study was conducted from February 2025 to July 2025 at selected hospitals in Khyber Pakhtunkhwa, including Pak Medical Centre and Hospital, Khyber Bazar, Peshawar. A total of 200 pediatric patients aged 3–9 years who underwent elective surgery under general anesthesia were included in the study. Data regarding demographic characteristics and perioperative effects associated with propofol and ketamine were collected and analyzed.
Results:
The study included 200 pediatric patients, of whom 167 (83.5%) were male and 33 (16.5%) were female. The patients were aged between 3 and 9 years, with a mean age of 5.5 years. Overall, changes in blood pressure were observed in 23% of patients, with a higher proportion reported among patients receiving propofol (38%). Changes in heart rate were observed in 27% of patients receiving ketamine compared with 46% among those receiving propofol. Respiratory depression occurred in 18% of patients overall and was reported in 32% of patients receiving propofol. These findings suggest greater hemodynamic and respiratory effects with propofol compared with ketamine in the studied pediatric population.
Conclusion:
The findings indicate that ketamine may provide greater cardiovascular and respiratory stability than propofol when used as an induction agent in pediatric patients undergoing elective surgery under general anesthesia. Compared with propofol, ketamine was associated with fewer reported changes in blood pressure and heart rate and a lower incidence of respiratory depression. Ketamine may therefore be considered a favorable induction agent in selected pediatric patients; however, appropriate patient selection, monitoring, and consideration of potential adverse effects are essential.