title: Midazolam-ketamine combination for moderate sedation in upper GI endoscopy.
abstract: OBJECTIVE
  The aim of the study was to compare the quality of sedation with 3 different sedation regimens in upper gastrointestinal endoscopy (UGIE) in pediatric patients.
  
  
  METHODS
  One hundred fifty consecutive children who underwent UGIE were randomly assigned to 1 of the 3 medication regimens. Patients in group A (n = 49) received placebo. Forty-five minutes after the placebo was given, repeated intravenous (IV) doses of 0.1 mg/kg midazolam were administered titrated to achieve a level of deep sedation. Patients in group B (n = 51) received oral ketamine instead of placebo, and patients in group C (n = 50) received oral fentanyl instead of placebo with the same methodology and sedation endpoint.
  
  
  RESULTS
  The mean dose of midazolam administered in group B patients was remarkably lower compared with that of groups A and C. Patients in group B showed less distress in IV line placement and separation from parents, higher comfort level, more endoscopist satisfaction, and higher sedation depth compared with groups A and C. The recovery time was significantly shorter in group B. All of the 3 regimens were safe. All of the complications were managed successfully.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Motamed
authors.forename: Yasaman
authors.initials: Y
authors.lastname: Aminpour
authors.forename: Hesam
authors.initials: H
authors.lastname: Hashemian
authors.forename: Alireza E
authors.initials: AE
authors.lastname: Soltani
authors.forename: Mehri
authors.initials: M
authors.lastname: Najafi
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Farahmand
mesh_terms: D000759:Adjuvants, Anesthesia / Q000494:pharmacology; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods* / Q000523:psychology; D054810:Deep Sedation / Q000379:methods / Q000523:psychology; D004338:Drug Combinations; D004357:Drug Synergism; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006282:Health Personnel; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology*; D007649:Ketamine / Q000494:pharmacology*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology*; D010146:Pain / Q000517:prevention & control; D010549:Personal Satisfaction; D013315:Stress, Psychological / Q000517:prevention & control*; D041742:Upper Gastrointestinal Tract
chemical_list: D000759:Adjuvants, Anesthesia; D000778:Anesthetics, Dissociative; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl