Ketamine versus propofol for procedural sedation in pediatric pulsed dye laser therapy: a prospective randomized trial

Background Pulsed dye laser (PDL) therapy is the gold standard for treating port-wine stains (PWS) in children but frequently requires procedural analgosedation due to pain and the need for immobility. The optimal sedative agent for repeated outpatient procedures remains unclear. Objective To compare the safety and efficacy of propofol- versus ketamine-based analgosedation in children undergoing PDL therapy, with a primary focus on respiratory depression. Methods In this prospective, randomized, controlled study, children aged 1–18 years (ASA I–II) were assigned to receive propofol or ketamine for PDL therapy. Standardized monitoring included electrocardiography, noninvasive blood pressure, pulse oximetry, and end-tidal CO₂. The primary outcome was respiratory depression, defined by predefined clinical and capnographic criteria. Secondary outcomes included hemodynamic instability, adverse events, drug consumption, procedural duration, sedation depth, and recovery time. Receiver operating characteristic (ROC) analysis was used to identify predictors of respiratory depression. Results A total of 310 procedures were analyzed. Respiratory depression was significantly more frequent in the propofol group compared with the ketamine group (19.5% vs. 2.6%, p < 0.01). Ketamine was associated with higher rates of hypertension, tachycardia, psychomimetic effects, and postoperative nausea and vomiting ( p < 0.01), whereas propofol was associated with more hypotension. Sedation and recovery times were longer with ketamine ( p < 0.01), while sedation depth was comparable between groups. A procedural duration ≥13.5 min predicted respiratory depression in the propofol group (AUC 0.755). Conclusion Both propofol and ketamine provide effective analgosedation for pediatric PDL therapy. Propofol is associated with a higher risk of respiratory depression, particularly during longer procedures, whereas ketamine offers greater respiratory stability but more other adverse effects. These findings support individualized anesthetic selection based on procedural duration and patient risk factors.