Pediatr Gastroenterol Hepatol Nutr.  2015 Sep;18(3):160-167. 10.5223/pghn.2015.18.3.160.

Efficacy and Safety of Low Dose Ketamine and Midazolam Combination for Diagnostic Upper Gastrointestinal Endoscopy in Children

Affiliations
  • 1Department of Pediatric Gastroenterology Hepatology and Nutrition, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey. ulasemre@hotmail.com

Abstract

PURPOSE
We aimed to analyze the effectiveness and safety of low-dose midazolam and ketamine combination for upper gastrointestinal endoscopy (UGIE) in children.
METHODS
The study included the children (n=425, 10.78+/-3.81 years) who underwent UGIE for diagnostic purpose during 1 year period. All children were sedated with low dose midazolam (0.1 mg/kg) and ketamine (0.5 mg/kg) intravenously. Effectiveness of the sedation and complications during the procedure and recovery period were recorded.
RESULTS
Endoscopic procedure was successfully completed in 414 patients (97.4%; 95% confidence interval, 95.8-98.9). Mean+/-standard deviation (SD) duration of procedure was 6.36+/-1.64 minutes (median, 6.0 minutes; range, 4-12 minutes). Minor complications occurred during the procedure in 39.2% of the patients. The most common complication was increased oral secretion (33.1%). No major complications were observed in any patient. Age and Ramsay sedation scores of patients with complications during the procedure were lower than the others (9.49+/-4.05 years vs. 11.61+/-3.43 years, p=0.002 and 2.10+/-1.46 vs. 4.37+/-1.16, p=0.001). Mean recovery time was 22 minutes (range, 10-90 minutes; mean+/-SD, 25+/-12.32 minutes). Minor complications developed during recovery in 60.1% of the patients. The most common complication was transient double vision (n=127, 30.7%). Emergence reaction was observed in 5 patients (1.2%).
CONCLUSION
The procedure was completed with high level of success without any major complication in our study. Combination of low-dose midazolam and ketamine is a suitable sedation protocol for pediatric endoscopists in UGIE.

Keyword

Endoscopy; Child; Conscious sedation

MeSH Terms

Child*
Conscious Sedation
Diplopia
Endoscopy
Endoscopy, Gastrointestinal*
Humans
Ketamine*
Midazolam*
Ketamine
Midazolam

Figure

  • Fig. 1 Study protocol.

  • Fig. 2 Ramsay sedation score (RSS) of the patients.

  • Fig. 3 Frequency of complications during the procedure.

  • Fig. 4 Frequency of complications during the recovery.


Cited by  1 articles

Propofol with and without Midazolam for Diagnostic Upper Gastrointestinal Endoscopies in Children
Ulas Emre Akbulut, Seyfi Kartal, Ufuk Dogan, Gulgun Elif Akcali, Serap Kalayci, Hulya Kirci
Pediatr Gastroenterol Hepatol Nutr. 2019;22(3):217-224.    doi: 10.5223/pghn.2019.22.3.217.


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