Comparison of low-dose ketamine to midazolam for sedation during pediatric urodynamic study.
BACKGROUND
Aim of sedation during pediatric urodynamic studies (UDS) is a calm and cooperative child while not affecting measurements. We compared the effectiveness of midazolam to low-dose ketamine infusion for sedation and their impact on urodynamics.


METHODS
ASA-I children undergoing UDS were randomly assigned to group K (ketamine) loading dose (0.25 mg·kg(-1)) followed by infusion of 10-20 μg·kg(-1) ·min(-1) or group M (midazolam) loading dose of (0.02 mg·kg(-1)) followed by 1-2 μg·kg(-1) ·min(-1). The sedation scores and reactivity to catheterization were monitored by Children Hospital of Wisconsin Sedation Scale and Frankl Behavior Rating Scale, respectively. The UDS included two-channel filling cystometry in supine position followed by a free uroflowmetry in sitting position. The UDS was performed and interpreted in accordance with good urodynamic practice guidelines of International Continence Society (2002).


RESULTS
A total of 34 children were enrolled. Group K children (n = 17) attained sedation earlier 6.80 (±3.36) min vs. 9.40 (±2.82) min; (P = 0.03) than group M (n = 17) and also recovered earlier 11.60 (±3.13) min vs. 19.67 (±5.49) min (P = 0.01). Reactivity scores during urinary and rectal catheterization were lower in group K (P = 0.03 and 0.01), respectively. Historical UDS data of 21 participants were available for comparison with effect of medication. None of the study drugs affected UDS parameters significantly.


CONCLUSIONS
Midazolam or low-dose ketamine provide satisfactory sedation during pediatric UDS without impacting urodynamic values.
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Arun K
AK
Thevaraja
Yatindra Kumar
YK
Batra
Sondekoppam V
SV
Rakesh
Nidhi B
NB
Panda
Katragadda L N
KL
Rao
Monica
M
Chhabra
Mayank
M
Aggarwal
D000778:Anesthetics, Dissociative / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D010100:Oxygen / Q000097:blood; D014563:Urodynamics; D014570:Urologic Diseases / Q000150:complications / Q000175:diagnosis
D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam; D010100:Oxygen