A comparison of sedation with midazolam–ketamine versus propofol–fentanyl during endoscopy in children: a randomized trial

Abstract

PurposeWe aimed to compare the efficacy and safety of midazolam plus ketamine versus fentanyl plus propofol combination administered to children undergoing upper gastrointestinal endoscopy (UGE) and to determine the most appropriate sedation protocol.Materials and methodsThis prospective, randomized, single-blind study included patients between the ages of 4 and 17 years who underwent UGE for diagnostic purposes. Patients were divided randomly into groups A (midazolam–ketamine combination, n=119) and B (fentanyl plus propofol combination, n=119). The effectiveness of the sedation and complications during the procedure and recovery period were recorded.ResultsThe processes started without an additional dose of the drug for 118 patients (99.1%) in group A and for 101 patients (84.8%) in group B (P=0.001). The average dose of ketamine administered to the patients in group A was 1.03±0.15 mg/kg and the average dose of propofol administered to the patients in group B was 1.46±0.55 mg/kg. None of the patients stopped the endoscopic procedure in group A, but one patient (0.8%) had to discontinue the endoscopic procedure in group B. 27 patients in group A (22.7%) and 41 patients (34.5%) in group B developed complications during the procedure (P=0.044). The rate of complications during the recovery of group A (110 patients, 92.4%) was significantly higher than that in group B (48 patients, 40.3%) (P=0.001).ConclusionIn children, UGE procedures can be quite comfortable when using the midazolam–ketamine combination. However, adverse effects related to ketamine were observed during recovery.

A Comparative Evaluation of Two Tiva Techniques for Day Care Surgical Procedures– Midazolam and Ketamine Versus Fentanyl and Propofol

“…25 patients had score of six, 15 minutes after stopping ketamine infusion whereas in Group B, 30 patients had score of six, 5 minutes after stopping propofol infusion, similar results were shown by Akbult et al that recovery time was less in propofolfentanyl combination. (28) Similar to Irwin MG et al study, it was observed that the patients were calm and quiet at the score of six in Group B. (13) In Group A, 46 patients were fit for discharge within two hours of completion of procedure and out of the 4 patients who were not discharged, 3 patients had severe emergence delirium so they were given sedation by injection diazepam and so could not be sent home.…”

“…(1) Akbult et al in their study concluded that in upper gastrointestinal endoscopic procedures midazolam-ketamine combination was comfortable as compared to propofol-fentanyl combination but propofolfentanyl combination had fewer side effects. (28) In both the Groups, recovery of patients was assessed by modified Steward Coma Score, maximum of six. It was seen that points comprising recovery in consciousness level were less in Group A as compared with Group B, than the points comprising the recovery in airway and activity.…”

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

“…However, as regarding the associated side effects, they found a significantly higher prevalence of nausea and vomiting in group PK (53.8%) in comparison to group PF (32.3%) (p=0.013). This can be explained by the higher incidence of vomiting in gastrointestinal procedures than in others [3]. Respiratory complications during recovery as bronchospasm, cough, stridor, and Laryngospasm were significantly higher in group PK (9%) in comparison to group PF (2%) (p=0.024).…”

“…Upper gastrointestinal endoscopy procedures in pediatric patients for diagnostic and therapeutic purposes have increased and become more frequent [3]. Choosing a sedative should be on the basis of its onset time, associated adverse effects and time to restore cognitive function after stopping it [28].…”

“…Guidelines for pharmacological intervention were issued by the American Academy of Pediatric Committee on drugs to classify it into 3 categories: Conscious sedation, deep sedation and general anesthesia [2]. Because it is difficult to adjust the level of sedation especially in designated areas outside the operating rooms [3] and deep sedation is required in the pediatric age group to allow successful procedures [4], sedatives should be prescribed cautiously and as per body weight and titrated according to their therapeutic effects [5,6]. Children usually required high doses of these medications [7].…”