Feasibility and safety of ketamine for procedural sedation in pediatric patients undergoing electrophysiology procedures: A cohort study.

INTRODUCTION

Electrophysiology (EP) procedures in the pediatric population are often performed aided by anesthetic support under general anesthesia (GA), provided they require a delicate balance between appropriate sedation depth, analgesia, immobility, and hemodynamic stability. GA is still the standard of care but shows several limitations. Ketamine sedation (KS) offers an alternative to GA with preserved respiratory and cardiovascular function, yet its role in pediatric EP procedures remains understudied.

METHODS

We retrospectively included 217 consecutive pediatric patients (<18 years) who underwent their first EP procedure at our center between 2016 and 2024. Patients received either KS (n = 37) or GA (n = 180) based on anesthesiologist and cardiologist preference. Primary endpoints were the GA conversion rate, perioperative complications, "door-to-door" operating room occupation time and postprocedural recovery time. Secondary endpoints included results of the electrophysiology study (EPS), change in electrocardiography parameters before, during and after drug infusion and difference of vital signs behavior between the two groups. Propensity score matching (PSM) was performed to correct for age, body mass index (BMI), type of procedure and sex.

RESULTS

Before PSM, compared with the GA group, the KS cohort was older (mean age 13.5 ± 4.5 vs. 11.3 ± 3.2 years in GA; p = 0.02), while sex distribution and BMI were similar. After PSM, there were no significant differences between the tested variables. No KS patient required GA conversion or experienced complications (e.g., emergence delirium). Shorter operating room door-to-door occupation time (KS 79.3 ± 47.2 min; p = 0.0026 vs GA 100.8 ± 37.2 min) and shorter recovery room time were reported in the KS group compared to the GA group (15 ± 19 min vs 41.5 ± 14 min; p = 0.001). No significant differences in the EPS result was observed between the two groups (19.4 % vs. 22.7 %; p = 0.59). In KS patients, electrocardiographic parameters remained stable before, during and at the end of procedure.

CONCLUSIONS

Ketamine-based sedation is a safe and effective alternative to GA for pediatric EP procedures, maintaining hemodynamic and electrocardiographic stability. Moreover, KS enhances operating room efficiency by reducing both periprocedural and recovery times.