A comparison of sedation with midazolam-ketamine versus propofol-fentanyl during endoscopy in children: a randomized trial.
OBJECTIVE
We 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.


METHODS
This 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.


RESULTS
The 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).


CONCLUSIONS
In children, UGE procedures can be quite comfortable when using the midazolam-ketamine combination. However, adverse effects related to ketamine were observed during recovery.
Departments of aPediatric Gastroenterology, Hepatology and Nutrition bAnesthesiology and Intensive Care Medicine, Kanuni Training and Research Hospital Departments of cAnesthesiology and Intensive Care Medicine dPediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
Ulas E
UE
Akbulut
Sedat
S
Saylan
Bilal
B
Sengu
Gulgun E
GE
Akcali
Engin
E
Erturk
Murat
M
Cakir
D000293:Adolescent; D000367:Age Factors; D002648:Child; D003243:Consciousness / Q000187:drug effects*; D004311:Double-Blind Method; D004338:Drug Combinations; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey
D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol
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