Ketamine–propofol versus fentanyl–propofol for sedation in pediatric circumcision: A randomized double-blind trial

Aim: Sedation for pediatric circumcision should ensure immobility, safety and rapid recovery. This randomized, double-blind trial compared ketamine–propofol with fentanyl–propofol in children.Methods: ASA I–II patients aged 5–10 years scheduled for elective circumcision were randomly assigned in a 1:1 ratio, without stratification or blocking to receive ketamine 1 mg/kg plus propofol 1 mg/kg (Group K) or fentanyl 1 μg/kg plus propofol 1 mg/kg (Group F). Sedation was titrated with 0.5 mg/kg propofol boluses to achieve a Ramsay Sedation Score > 5. The primary outcome was the total propofol consumption. Secondary outcomes included extremity movements (defined as gross extremity movement requiring interruption of the procedure or additional sedative administration), surgeon satisfaction, recovery time to Modified Aldrete Score ≥9, behavioral scores, pain scores, oxygen saturation and adverse events.Results: Sixty of the 68 screened children were analyzed (n = 30 per group). Total propofol consumption was lower in Group K than in Group F (2.0 ± 0.6 vs. 3.3 ± 1.3 mg/kg; p < 0.001). Intraoperative movements were less frequent in Group K (3.5 ± 2.3 vs. 6.0 ± 2.9; p < 0.001). Recovery time and the incidence of adverse events were comparable between the groups. Heart rate trajectories were similar. Although SpO₂ values were higher in Group K at most intraoperative and early postoperative time points (p < 0.05), oxygen saturation remained within clinically acceptable limits in both groups and desaturation events were similar. Surgeon satisfaction, emergence behavior and pain scores were similar.Conclusions: In pediatric circumcision, Group K provides lower propofol requirements and fewer intraoperative movements than Group F without prolonging recovery, increasing adverse events or lowering oxygen saturation. This is an effective and safe regimen that may improve operative conditions.