Comparative Study Between Intravenous Ketamine and Propofol as Induction Agents on Postoperative Recovery Scores in Neonates Undergoing Tracheoesophageal Fistula (TEF) Repair Surgery

Objective: Tracheoesophageal fistula (TEF) is a congenital anomaly necessitating early surgical intervention.Enhanced recovery after surgery -ERAS principles are increasingly applied in neonatal surgical care to improve outcomes.The choice of anesthetic induction agent plays a pivotal role in determining recovery quality and duration.Method: This was a randomized, double-blind, prospective clinical trial involving 60 neonates under 10 days old undergoing TEF repair.Subjects were assigned to receive either propofol (1.5 mg kg -1 ) or ketamine (1 mg kg -1 ) as induction agents, with standard maintenance anesthesia and postoperative care.The primary outcome was recovery score at extubation using the Modified Steward Score.Secondary outcomes included duration of mechanical ventilation, postoperative pain using the neonatal pain agitation and sedation scale, and hemodynamic stability.Results: Recovery scores were significantly higher in the propofol group (mean 4.86 0.89) compared to the ketamine group (mean 3.09 1.01) (p<0.001).The mean duration of mechanical ventilation was shorter in the propofol group (18.00 3.70 h) than in the ketamine group (21.45 2.55 h), (p=0.001).Postoperative pain scores were consistently lower in the ketamine group at all time intervals, with significant differences (p<0.05).Hemodynamic parameters were more stable and elevated in the ketamine group post-induction.Conclusion: Propofol is associated with faster recovery and reduced ventilation time, whereas ketamine offers superior postoperative analgesia and hemodynamic stability.Anesthetic choice should be individualized based on surgical and patient-specific needs.