Archives of Anesthesiology and Critical Care 2016. 2(3):222-225.

Comparison of Propofol-Ketamine vs Propofol-Fentanyl for Pediatric Sedation during Upper Gastrointestinal Endoscopy
Alireza Takzare, Alireza Ebrahim Soltani, Anahid Maleki, Behrang Nooralishahi, Fariba Kaheh, Sagar Arab, Mehrdad Goudarzi

Abstract


Background: Selection of the best sedative regimen during pediatric endoscopy with greater stability in hemodynamic parameters and fewer side effects is very important. The aim of this study was to compare the clinical efficacy and safety of propofol – ketamine versus propofol – fentanyl in pediatric undergoing diagnostic upper gastrointestinal endoscopy (UGIE).

Methods: In this clinical trial, 130 children aged 2 to 12 years (ASA physical status I or II) were examined. Children were divided into two groups. Propofol (1.2 mg/kg) plus ketamine (1 mg/kg) was prescribed for the first group (Group PK). The second group received propofol (1.2 mg/kg) plus fentanyl (1 µg/kg) (Group PF). Hemodynamic variables and sedation scale of patients were compared between two groups.

Results: The mean age of the children was 98.3±6.96 months and 97.15±3.56 months in group PK and group PF, respectively. Heart rate and respiratory rate values after induction in group PF were significantly lower than in group PK (p<0.05). Coughing, nausea and vomiting and Ramsey sedation score were significantly higher in group PK (p<0.05).

Conclusion: Both combinations provided effective sedation in pediatric patients undergoing UGIE, but the propofol-ketamine combination resulted in stable hemodynamics and deeper sedation although with more side effects.


Keywords


sedation; children; ketamine; propofol; fentanyl; endoscopy

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References


Mahajan L, Wyllie R, Steffen R, Kay M, Kitaoka G, Dettorre J, et al. The effects of a psychological preparation program on anxiety in children and adolescents undergoing gastrointestinal endoscopy. J Pediatr Gastroenterol Nutr. 1998; 27(2):161-5.

Coté CJ, Wilson S; Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006; 118(6):2587-602.

Abbas MI, Nylund CM, Bruch CJ, Nazareno LG, Rogers PL. Prospective evaluation of 1-day polyethylene glycol-3350 bowel preparation regimen in children. J Pediatr Gastroenterol Nutr. 2013; 56(2):220-4.

Jibaly R, LaChance J, Lecea NA, Ali N, Weber JE. The utility of PEG3350 without electrolytes for 2-day colonoscopy preparation in children. Eur J Pediatr Surg. 2011; 21(5):318-21.

Terry NA, Chen-Lim ML, Ely E, Jatla M, Ciavardone D, Esch S, et al. Polyethylene glycol powder solution versus senna for bowel preparation for colonoscopy in children. J Pediatr Gastroenterol Nutr. 2013; 56(2):215-9.

Jimenez-Rivera C, Haas D, Boland M, Barkey JL, Mack DR. Comparison of two common outpatient preparations for colonoscopy in children and youth. Gastroenterol Res Pract. 2009; 2009:518932.

Safder S, Demintieva Y, Rewalt M, Elitsur Y. Stool consistency and stool frequency are excellent clinical markers for adequate colon preparation after polyethylene glycol 3350 cleansing protocol: a prospective clinical study in children. Gastrointest Endosc. 2008; 68(6):1131-5.

Adamiak T, Altaf M, Jensen MK, Sultan M, Ramprasad J, Ciecierega T, et al. One-day bowel preparation with polyethylene glycol 3350: an effective regimen for colonoscopy in children. Gastrointest Endosc. 2010; 71(3):573-7.

Fredette ME, Lightdale JR. Endoscopic sedation in pediatric practice. Gastrointest Endosc Clin N Am. 2008; 18(4):739-51

Barbi E, Gerarduzzi T, Marchetti F, Neri E, Verucci E, Bruno I, et al. Deep sedation with propofol by nonanesthesiologists: a prospective pediatric experience. Arch Pediatr Adolesc Med. 2003; 157(11):1097-103.

Amornyotin S, Aanpreung P, Prakarnrattana U, Chalayonnavin W, Chatchawankitkul S, Srikureja W. Experience of intravenous sedation for pediatric gastrointestinal endoscopy in a large tertiary referral center in a developing country. Paediatr Anaesth. 2009; 19(8):784-91.

Amornyotin S, Aanpreung P. Clinical effectiveness of an anesthesiologist-administered intravenous sedation outside of the main operating room for pediatric upper gastrointestinal endoscopy in Thailand. Int J Pediatr. 2010; 2010. pii: 748564.

Green SM, Krauss B. Propofol in emergency medicine: pushing the sedation frontier. Ann Emerg Med. 2003; 42(6):792-7. Erratum in: Ann Emerg Med. 2004; 43(1):142.

Green SM, Krauss B. The semantics of ketamine. Ann Emerg Med. 2000;36(5):480-2.

Dar AQ, Shah ZA. Anesthesia and sedation in pediatric gastrointestinal endoscopic procedures: A review. World J Gastrointest Endosc. 2010; 2(7):257-62.

Algren CL, Algren JT. Pediatric sedation. Essentials for the perioperative nurse. Nurs Clin North Am. 1997; 32(1):17-30.

Tosun Z, Aksu R, Guler G, Esmaoglu A, Akin A, Aslan D, et al. Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy. Paediatr Anaesth. 2007; 17(10):983-8.

Kb N, Cherian A, Balachander H, Kumar C Y. Comparison of Propofol and Ketamine versus Propofol and Fentanyl for Puerperal Sterilization, A Randomized Clinical Trial. J Clin Diagn Res. 2014; 8(5):GC01-4.

Khutia SK, Mandal MC, Das S, Basu SR. Intravenous infusion of ketamine-propofol can be an alternative to intravenous infusion of fentanyl-propofol for deep sedation and analgesia in paediatric patients undergoing emergency short surgical procedures. Indian J Anaesth. 2012; 56(2):145-50.

Singh R, Arora M, Vajifdar H. Randomized double-blind comparison of ketamine-propofol and fentanyl-propofol for the insertion of laryngeal mask airway in children. J Anaesthesiol Clin Pharmacol. 2011; 27(1):91-6.

Chandar R, Jagadisan B, Vasudevan A. Propofol-ketamine and propofol-fentanyl combinations for nonanesthetist-administered sedation. J Pediatr Gastroenterol Nutr. 2015; 60(6):762-8.

Ghatak T, Singh D, Kapoor R, Bogra J. Effects of addition of ketamine, fentanyl and saline with Propofol induction on hemodynamics and laryngeal ask airway insertion conditions in oral clonidine premedicated children. Saudi J Anaesth. 2012; 6(2):140-4.


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