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

• Akbulut UE
• Cakir M

• KMID: 2068792
• DOI: http://doi.org/10.5223/pghn.2015.18.3.160

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

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  Fig. 1 Study protocol.

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

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  Fig. 3 Frequency of complications during the procedure.

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  Fig. 4 Frequency of complications during the recovery.

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