Ketamine for pediatric EP procedures: minimizing time, maximizing safety
F Fioravanti, A Barengo, J D'andria Ursoleo, N Tanese, F Monaco, A Zangrillo, P Gianfico, F M Cauti, V Martello, F Caparra, P E Della Bella, S GullettaAbstract
General anesthesia (GA) remains the standard for pediatric electrophysiology (EP) procedures, yet it prolongs workflow and recovery and may blunt autonomic tone, affecting arrhythmia inducibility. Ketamine sedation (KS) offers an appealing alternative, combining deep analgesia with preserved spontaneous breathing and stable hemodynamics.
In this single-center retrospective cohort (2016–2024), 217 consecutive pediatric patients (<18 years) undergoing their first EP procedure (WPW-EPS, SVT, AVRT, AVNRT) received either KS (n = 37) or GA (n = 180). Primary endpoints were total procedural ("door-to-door") time, recovery room duration, and peri-procedural safety. Propensity score matching (1:1) adjusted for age, sex, BMI, and procedure type.
KS proved remarkably efficient and safe: no conversion to GA, no airway events, and no emergence agitation. Compared with GA, KS significantly shortened operating room occupation (79 ± 47 vs 101 ± 37 min; p = 0.0026) and recovery time (15 ± 19 vs 42 ± 14 min; p = 0.001). These differences persisted after matching (80 ± 35 vs 100 ± 32 min; p = 0.048; 16 ± 18 vs 39 ± 15 min; p = 0.004). Hemodynamic and ECG parameters remained stable throughout.
Conclusion: Ketamine-based deep sedation provides a safe, time-saving, and workflow-enhancing strategy for pediatric EP procedures. By eliminating airway manipulation and minimizing recovery, KS redefines the balance between efficiency and safety in pediatric electrophysiology — a practical step toward lighter, smarter anesthesia