Midazolam‐Ketamine Combination for Moderate Sedation in Upper GI Endoscopy

Motamed, Farzaneh; Aminpour, Yasaman; Hashemian, Hesam; Soltani, Alireza E.; Najafi, Moslem; Farahmand, Fatemeh

doi:10.1097/mpg.0b013e3182323c75

Cited by 32 publications

(26 citation statements)

References 34 publications

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“…In the meta-analysis carried out, although side effects occurred in 30% of the adults, they only occurred in 1.4% of the children 31. The incidence of emergence reactions increases, especially when ketamine is used at high doses, when a fast injection (<1 minute) is administered and when excessive visual or verbal stimuli exist during the recovery 2,4. In our previous study, we used 0.5 mg/kg ketamine and the emergence reaction was 1.2%.…”

Section: Discussionmentioning

confidence: 99%

“…Vomiting occurs more often in gastrointestinal tract procedures than in other processes. Motamed et al 4 reported that vomiting occurred in 17.6% of the children who underwent UGE procedures. Some studies have reported that administration of atropine along with ketamine sedation reduces vomiting, but there is no consensus on this issue 37–39.…”

Section: Discussionmentioning

confidence: 99%

“…When used for sedation and anaesthesia, ketamine causes dissociative anaesthesia characterized by amnesia and analgesia 4,5. However, side effects such as aspiration, stridor, laryngospasm and after-sedation nausea have been reported 6,7.…”

Section: Introductionmentioning

confidence: 99%

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

Akbulut¹,

Saylan²,

Sengu³

et al. 2017

European Journal of Gastroenterology &Amp; Hepatology

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Akbulut¹,

Saylan²,

Sengu³

et al. 2017

European Journal of Gastroenterology &Amp; Hepatology

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“…In another study comparing midazolam-ketamine, midazolam-placebo and midazolam-fentanyl, dizziness, vomiting and cough were most frequently observed in the midazolam-ketamine group and a significant difference was observed between the midazolam-ketamine group and the midazolam-fentanyl group in terms of diplopia and vomiting ( p =0.004 and 0.002, respectively) [19]. …”

Section: Discussionmentioning

confidence: 99%

Investigation of Efficacy of Lidocaine Spray for Sedated Esophagogastroduodenoscopy in Children

Baştürk

Artan

Yılmaz

2017

Pediatr Gastroenterol Hepatol Nutr

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PurposeOur aim in this study is to investigate efficacy of topical lidocaine spray for sedated esophagogastroduodenoscopy (EGD) in children.MethodsThe endoscopy of children aged between 3-18 years who underwent EGD in our endoscopy unit. Intravenous (IV) midazolam and ketamine were used for sedation. Prior to sedation, endoscopy nurse applied topical lidocaine 10% with pump spray at 1 mg/kg dose in group 1, and distilled water via identically scaled pump spray in group 2, in a double blinded fashion.ResultsSedation was not applied in 24.1% of the cases in topical lidocaine spray group (LS group) and in 5.7% of the cases in distilled water spray group (DS group). Gag reflex was observed in 6.5% of cases in LS group and 33.3% of cases in DS group (p=0.024), increased oral secretion was observed in 9.3% of cases in LS group and 51.7% of cases in DS group (p=0.038), sore throat was observed in 3.7% of cases in LS group and 35.6% of cases in DS group (p=0.019) and the difference was statistically significant.ConclusionThe study showed that topical pharyngeal lidocaine reduces both requirement and amount of IV sedation before EGD in children and sore throat, gag reflex and decreased oral secretion increase.

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“…To prevent or reduce these complications, other analgesic medications can be used in place of fentanyl (2, 3, 16). Studies have shown that the combination of ketamine and propofol can effectively prevent deep sedation of patients and cause lower postoperative nausea and vomiting, more stable hemodynamics, and a shorter discharge time after ERCP (11, 12, 16-18). …”

Section: Introductionmentioning

confidence: 99%

Sedative and Analgesic Effects of Propofol-Fentanyl Versus Propofol-Ketamine During Endoscopic Retrograde Cholangiopancreatography: A Double-Blind Randomized Clinical Trial

et al. 2016

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BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) is a painful procedure that requires analgesia and sedation.ObjectivesIn this study, we compared the analgesic and sedative effects of propofol-ketamine versus propofol-fentanyl in patients undergoing ERCP.MethodsIn this clinical trial, 72 patients, aged 30 - 70 years old, who were candidates for ERCP were randomly divided into two groups. Before the start of ERCP, both groups received midazolam 0.5 - 1 mg. The intervention group (PK) received ketamine 0.5 mg/kg, and the control group (PF) received fentanyl 50 - 100 micrograms. All patients received propofol 0.5 mg/kg in a loading dose followed by 75 mcg/kg/minute in an infusion. The patients, the anesthesiologist, and the endoscopist were unaware of the medication regimen. Sedation and analgesia quality (based on a VAS), blood pressure, respiratory rate, heart rate, arterial oxygen saturation, recovery time (based on Aldrete scores), and endoscopist and patient satisfation were recorded.ResultsThe sedative effects were equal in the two groups (P > 0.05), but the analgesic effects were higher in the PF group than in the PK group (P < 0.05). The PK group had higher blood pressure levels in the eighth minute. Respiratory rate, heart rate, and arterial oxygen saturation showed no significant differences between the groups (P > 0.05). Endoscopist satisfaction, patient satisfaction, and recovery time showed no significant differences between the two groups (P > 0.05).ConclusionsThe results showed that the sedative effect of propofol-ketamine was equal to the propofol-fentanyl combination during ERCP. To prevent respiratory and hemodynamic complications during ERCP, the propofol-ketamine combination should be used in patients with underlying disease.

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Midazolam‐Ketamine Combination for Moderate Sedation in Upper GI Endoscopy

Abstract: Our data suggest that synergistic sedation with oral ketamine and IV midazolam for UGIE in children is a suitable and safe sedation. The higher rate of vomiting in group B in contrast to previous studies must be caused mainly by the oral route of ketamine administration.

Cited by 32 publications

References 34 publications

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

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

Investigation of Efficacy of Lidocaine Spray for Sedated Esophagogastroduodenoscopy in Children

Sedative and Analgesic Effects of Propofol-Fentanyl Versus Propofol-Ketamine During Endoscopic Retrograde Cholangiopancreatography: A Double-Blind Randomized Clinical Trial

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