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J Pediatr Intensive Care 2022; 11(01): 019-025
DOI: 10.1055/s-0040-1721657
Original Article

Comparison of Ketamine and Propofol-Based Regimens for Deep Sedation in Children Undergoing Esophagogastroduodenoscopy

Olugbenga Akingbola
1   Division of Pediatric Critical Care, Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, United States
,
Sudesh K. Srivastav
2   Department of Biostatistics and Data Science, Tulane University, New Orleans, Louisiana, United States
,
Michelle Nguyen 
3   Tulane University School of Medicine, New Orleans, Louisiana, United States
,
Dinesh Singh 
4   Baylor Scott and White McLane Children's Medical Center, Temple, Texas, United States
,
Edwin M. Frieberg
1   Division of Pediatric Critical Care, Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, United States
,
Amy Thibodeaux
5   Ochsner Health System, New Orleans, Louisiana, United States
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Abstract

We retrospectively reviewed the charts of 180 children sedated for esophagogastroduodenoscopy (EGD) with ketamine or propofol-based regimens at our institution. Pre-EGD diagnoses and American Society of Anesthesiology physical status were similar in all subjects. Onset of action and recovery time for both regimens were not statistically significant (p > 0.05). Mean onset of sedation for all patients was 3.85 ± 3.04 minutes, mean Aldrete score was 6.31 ± 0.61, and mean recovery time was 51.85 ± 31.78 minutes (p > 0.05). Sedation-related adverse events observed include apnea, hypoxemia, bradycardia, hypotension, laryngospasm, skin rash, and wheezing. Deep sedation for pediatric EGD is safe if patients are carefully screened and properly monitored.

Keywords

pediatric EGD - artificial airway - procedural sedation

Note

This study was presented as an electronic abstract at the 2019 annual meeting of the American Society of Anesthesiology.




Publication History

Received: 31 May 2020

Accepted: 19 September 2020

Article published online:
23 November 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Coté CJ, Wilson S. American Academy of Pediatrics, American Academy of Pediatric Dentistry, 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 (06) 2587-2602
    CrossrefPubMedGoogle Scholar
  • 2 American Society of Anesthesiologists, Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96 (04) 1004-1017
    CrossrefPubMedGoogle Scholar
  • 3 Fox V. Upper gastrointestinal endoscopy. In: Walker WA, Durie PR, Hamilton JR, Walker-Smith JA, Watkins JB. eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. St. Louis: Mosby; 2000: 1514-1532
    Google Scholar
  • 4 Liacouras CA, Mascarenhas M, Poon C, Wenner WJ. Placebo-controlled trial assessing the use of oral midazolam as a premedication to conscious sedation for pediatric endoscopy. Gastrointest Endosc 1998; 47 (06) 455-460
    CrossrefPubMedGoogle Scholar
  • 5 Squires Jr RH, Morriss F, Schluterman S, Drews B, Galyen L, Brown KO. Efficacy, safety, and cost of intravenous sedation versus general anesthesia in children undergoing endoscopic procedures. Gastrointest Endosc 1995; 41 (02) 99-104
    CrossrefPubMedGoogle Scholar
  • 6 Lightdale JR. Sedation for pediatric endoscopy. Tech Gastrointest Endosc 2013; 15: 3-8
    CrossrefPubMedGoogle Scholar
  • 7 Chen PH, Wu TC, Chiu CY. Pediatric gastrointestinal endoscopic sedation: a 2010 nationwide survey in Taiwan. Pediatr Neonatol 2012; 53 (03) 188-192
    CrossrefPubMedGoogle Scholar
  • 8 van Beek EJ, Leroy PL. Safe and effective procedural sedation for gastrointestinal endoscopy in children. J Pediatr Gastroenterol Nutr 2012; 54 (02) 171-185
    CrossrefPubMedGoogle Scholar
  • 9 Lightdale JR, Valim C, Newburg AR, Mahoney LB, Zgleszewski S, Fox VL. Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: a prospective study. Gastrointest Endosc 2008; 67 (07) 1067-1075
    CrossrefPubMedGoogle Scholar
  • 10 Abu-Shahwan I, Mack D. Propofol and remifentanil for deep sedation in children undergoing gastrointestinal endoscopy. Paediatr Anaesth 2007; 17 (05) 460-463
    CrossrefPubMedGoogle Scholar
  • 11 Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991; 37 (04) 421-427
    CrossrefPubMedGoogle Scholar
  • 12 Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995; 7 (01) 89-91
    CrossrefPubMedGoogle Scholar
  • 13 Newton T, Pop I, Duvall E. Sedation scales and measures--a literature review. SAAD Dig 2013; 29: 88-99
    PubMedGoogle Scholar
  • 14 Dar AQ, Shah ZA. Anesthesia and sedation in pediatric gastrointestinal endoscopic procedures: a review. World J Gastrointest Endosc 2010; 2 (07) 257-262
    CrossrefPubMedGoogle Scholar
  • 15 Lewis Claar R, Walker LS, Barnard JA. Children's knowledge, anticipatory anxiety, procedural distress, and recall of esophagogastroduodenoscopy. J Pediatr Gastroenterol Nutr 2002; 34 (01) 68-72
    CrossrefPubMedGoogle Scholar
  • 16 Green SM, Klooster M, Harris T, Lynch EL, Rothrock SG. Ketamine sedation for pediatric gastroenterology procedures. J Pediatr Gastroenterol Nutr 2001; 32 (01) 26-33
    CrossrefPubMedGoogle Scholar
  • 17 Gil Gavel FRCA, Robert WM. Walker, FRCA. Laryngospasm in anaesthesia. Contin Educ Anaesth Crit Care Pain 2014; 14 (02) 47-51
    CrossrefPubMedGoogle Scholar
  • 18 Lightdale JR, Mitchell PD, Fredette ME. et al. A pilot study of ketamine versus midazolam/fentanyl sedation in children undergoing GI endoscopy. Int J Pediatr 2011; 2011: 623710
    CrossrefPubMedGoogle Scholar
  • 19 Oh SH. Sedation in pediatric esophagogastroduodenoscopy. Clin Endosc 2018; 51 (02) 120-128
    CrossrefPubMedGoogle Scholar
  • 20 Brecelj J, Trop TK, Orel R. Ketamine with and without midazolam for gastrointestinal endoscopies in children. J Pediatr Gastroenterol Nutr 2012; 54 (06) 748-752
    CrossrefPubMedGoogle Scholar
  • 21 Motamed F, Aminpour Y, Hashemian H, Soltani AE, Najafi M, Farahmand F. Midazolam-ketamine combination for moderate sedation in upper GI endoscopy. J Pediatr Gastroenterol Nutr 2012; 54 (03) 422-426
    CrossrefPubMedGoogle Scholar
  • 22 Barbi E, Petaros P, Badina L. et al. Deep sedation with propofol for upper gastrointestinal endoscopy in children, administered by specially trained pediatricians: a prospective case series with emphasis on side effects. Endoscopy 2006; 38 (04) 368-375
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Larsen R, Galloway D, Wadera S. et al. Safety of propofol sedation for pediatric outpatient procedures. Clin Pediatr (Phila) 2009; 48 (08) 819-823
    CrossrefPubMedGoogle Scholar
  • 24 Chiaretti A, Benini F, Pierri F. et al. Safety and efficacy of propofol administered by paediatricians during procedural sedation in children. Acta Paediatr 2014; 103 (02) 182-187
    CrossrefPubMedGoogle Scholar
  • 25 Motas D, McDermott NB, VanSickle T, Friesen RH. Depth of consciousness and deep sedation attained in children as administered by nonanaesthesiologists in a children's hospital. Paediatr Anaesth 2004; 14 (03) 256-260
    CrossrefPubMedGoogle Scholar
  • 26 Vargo JJ, Zuccaro Jr G, Dumot JA, Conwell DL, Morrow JB, Shay SS. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy. Gastrointest Endosc 2002; 55 (07) 826-831
    CrossrefPubMedGoogle Scholar
  • 27 Alletag MJ, Auerbach MA, Baum CR. Ketamine, propofol, and ketofol use for pediatric sedation. Pediatr Emerg Care 2012; 28 (12) 1391-1395 , quiz 1396–1398
    CrossrefPubMedGoogle Scholar
  • 28 Takzare A, Sottani AE, Maleki A. et al. Comparison of propofol-ketamine vs propofol fentanyl for pediatric sedation during upper gastrointestinal endoscopy. Archives of Anesthesiology and Critical Care 2016; 2 (03) 216-225
    PubMedGoogle Scholar