A Comparison of Ketamine-Dexmedetomidine versus Ketamine-Propofolfor Sedation in Children during Upper Gastrointestinal Endoscopy

Abstract

Background: Upper gastrointestinal endoscopy in pediatric patients have increased and become more frequent. Selection of a sedative with hemodynamic stability, rapid onset, short action and few side effects is essential.

Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial

“…Mogahed and Salama compared Ketamine-Dexmedetomidine (KD) to ketamine-propofol (KP) in sedating children undergoing upper gastrointestinal endoscopy. 23 They found no significant difference between both groups in SpO 2 . The older age group in their study (2−12 years) compared to ours (2−7 years), with respiratory adverse events being more frequent in younger age group.…”

The comparison of ketamine-dexmedetomidine (ketadex) and ketamine-propofol (ketofol) for procedural sedation in pediatric patients: A meta-analysis of randomized controlled trials

“…After screening the full text, 3 studies did not report relevant outcomes. Finally, 9 studies involving 565 children were included in this meta-analysis [ 2 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].

Figure 1 Flowchart of study selection process.

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“… Author (Year) Age Procedure ketadex/ketofol Dose of ketadex Dose of ketofol Outcomes Ali (2015) [ 10 ] 1-12 y Cardiac catheterization 29/30 Beginning: 1 mg/kg K+1 μg/kg D Maintenance: 1 mg/kg K when required Beginning: 1 mg/kg K+50 μg/kg/min P Maintenance: 1 mg/kg K when required Adverse events Recovery time Amer (2020) [ 11 ] 2-7 y Gastrointestinal endoscopy 60/60 Beginning: 1 mg/kg K+0.5 μg/kg D Maintenance: 0.5 μg/kg D when required Beginning: 1 mg/kg K+1 mg/kg P Maintenance: 1 mg/kg P when required 1.Adverse events 2.Clinicians' satisfaction Azizkhani (2021) [ 12 ] 3-17 y Emergency department procedures 31/31 Beginning: 1 mg/kg K+0.7 μg/kg D Maintenance: 0.25 mg/kg K when required Beginning: 0.5 mg/kg K+0.5 mg/kg P Maintenance: 0.25 mg/kg K when required 1.Adverse events Canpolat (2012) [ 13 ] 8–60 m Burn wound management 30/30 Beginning: 1 mg/kg K+0.5 μg/kg D Maintenance: 0.5 μg/kg D when required Beginning: 1 mg/kg K+1 mg/kg P Maintenance: 1 mg/kg P when required 1.Adverse events 2.Clinicians' satisfaction 3. Recovery time Canpolat (2017) [ 14 ] 2-8 y Tooth extraction 30/30 Beginning: 1 mg/kg K+0.5 μg/kg D Maintenance: 0.25 μg/kg D when required Beginning: 1 mg/kg K+1 mg/kg P Maintenance: 0.5 mg/kg P when required 1.Adverse events 2.Clinicians' satisfaction Recovery time Mogahed (2017) [ 15 ] 2-12 y Gastrointestinal endoscopy ...…”

Perbandingan Dexmedetomidine 1 mcg/kgBB Intravena Dan Fentanyl 2 mcg/kgBB Intravena Terhadap Mula Kerja, Efek Hemodinamik Dan Waktu Pulih Sadar Selama Anestesi Endoskopi Retrograde Cholangiopancreatography

“…Hal ini sesuai dengan penelitian Mona pada tahun 2017 bahwa ada perbedaan signifikan terhadapat denyut jantung dalam perbandingan antara ketamin -dexmedetomidine dengan ketamin -propofol, dimana penurunan denyut jantung terjadi pada kelompok ketamindexmedetomidine pada T1, T2, dan T3 dari data penelitian. 16 Menurut Muller et al dalam penelitiannya untuk menguji efektifitas dexmedetomidine dengan propofol -fentanyl sebagai sedasi pada tindakan ERCP bahwa ada penurunan tekanan darah yang lebih besar, detak jantung yang lebih rendah, dan sedasi yang lebih besar setelah prosedur apabila dexmedetomidine digunakan sebagai obat tunggal sebagai sedasi dalam tindakan ERCP. 17 Dalam penelitian Srivastava et al dilakukan pemberian dosis induksi propofol dipandu oleh BIS setelah dosis awal yang sama dexmedetomidine dan diamati perubahan hemodinamik.…”