Paediatric sedation during upper gastrointestinal endoscopy: Comparison of propofol + ketamine vs sodium thiopental + fentanyl

Abstract

Background: Different drug regimens can be used for management of anxiety before endoscopy. This study aimed to compare the sedation effects of propofol+ketamine (PK) and sodium thiopental+fentanyl (TF) in children during upper gastrointestinal (UGI) endoscopy. Methods: A triple-blind clinical trial was conducted on 88 children aged 2-12 years who were candidate for UGI endoscopy at Children's Medical Centre, Tehran, Iran, during 2012-2013. It was administered propofol (2.1 mg/kg) + ketamine (1 mg/kg) and 100% oxygen in PK group, and thiopental (5 mg/kg) + fentanyl (1 mg/kg) in TF group. The haemodynamic status and degree of sedation by Ramsay's criteria were measured. Results: The mean age in PK and TF groups was 92.2±38.2 and 98.6±49.5 months, respectively. The systolic blood pressure and heart rate significantly increased and decreased in PK and TF groups during the procedure, respectively. The frequency of Ramsay's Sedation Scales of 5 and 6 were respectively 72.7% and 27.3% for PF, and 54.5% and 45.5% for TF group (p=0.076). Conclusion: Although both groups were similar in the degree of sedation, PK can be a more appropriate choice for sedation in children with special diseases undergoing endoscopy due to small changes in haemodynamic parameters and, consequently, their higher stability.

Sedación profunda en endoscopia digestiva superior terapéutica en niños

“…Todo ello, hace necesario el uso de sedación en la ejecución del procedimiento médico. [4][5] Todo sedante se suele administrar para conseguir tres objetivos: (a) bridar confort al paciente y suprimir la respuesta fisiológica al estrés; (b) permitir que el paciente tolere mejor el procedimiento; y (c) como terapia en sí mismo. Actualmente, se ha extendido el uso de la sedación profunda en pacientes pediátricos que requieren diagnósticos o tratamientos mediante EDS.…”

Inhalation of Sevoflurane Versus Intravenous Ketamine, Midazolam and Propofol For Sedation in Pediatrics Undergoing Upper Gastrointestinal Endoscopy

“…Although intubation is not routinely performed for UGE, a number of problems, including airway obstruction, respiratory depression, laryngospasm, and hypoxemia, could still develop. Children are more likely to experience episodes of hypoxemia due to their increased oxygen consumption, and they are also more susceptible to developing hyperactive airways following the onset of upper respiratory tract infections [3,4]. Several studies have been performed to determine the most effective technique for procedural sedation regarding the quality, easiness of utilization, recovery characters and safety of sedation, however it seems that there is no clear agreement.…”