Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial
“…After screening the full text, 3 studies did not report relevant outcomes. Finally, 9 studies involving 565 children were included in this meta-analysis [ 2 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Figure 1 Flowchart of study selection process.…”
“…After screening the full text, 3 studies did not report relevant outcomes. Finally, 9 studies involving 565 children were included in this meta-analysis [ 2 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Figure 1 Flowchart of study selection process.…”
“…Amer et al conducted a similar study on the effect of adding ketamine to dexmedetomidine and propofol during gastrointestinal endoscopy in children, finding that hemodynamic parameters did not differ significantly between the Ketofol and Ketadex groups (24). However, the mean SpO 2 was higher in the Ketofol group than in the Ketadex group (24).…”
Section: Discussionmentioning
confidence: 99%
“…In addition, Xu et al stated that both esketaminepropofol and dexmedetomidine-propofol administration produced the same sedation for pediatric patients undergoing 3 Tesla (T) magnetic resonance imaging (MRI), though esketamine-propofol sedation reduced the need for propofol without increasing side effects (36). Another study in children undergoing gastrointestinal endoscopic procedures also showed that post-procedure nausea and vomiting were less in the Ketofol group than in the Ketadex group; however, there was no difference in endoscopic satisfaction between the 2 groups (24).…”
Section: Discussionmentioning
confidence: 99%
“…In this regard, the results of some recent reports have indicated that the combination of sedative medicines such as propofol, dexmedetomidine, and ketamine can neutralize the adverse effects of each other and create the best and most effective sedation with the least adverse effects for the patient by prescribing the minimum dose of these medicines (11,19,(21)(22)(23)(24).…”
Background: As endoscopy is an invasive and painful procedure, it is necessary to use a suitable sedative with a minimum dose, especially in children. Objectives: This study aimed to compare the effect of adding low-dose ketamine to dexmedetomidine and propofol on the quality of sedation and hemodynamic response in children during upper gastrointestinal endoscopy. Methods: This double-blind, randomized clinical trial was conducted on 52 children who were candidates for endoscopy in 2 groups, each consisting of 26 patients. In the first group (Ketadex group), infusion of dexmedetomidine (0.7 - 1 μg/kg) for 10 minutes and ketamine bolus (0.4 mg/kg) for anesthesia induction was prescribed. In the second group (Ketofol group), infusion of propofol (50 - 100 μg/kg) for 10 minutes and ketamine bolus (0.4 mg/kg) for anesthesia induction was prescribed. Results: The mean blood pressure of children decreased slightly during and after the endoscopic procedure in the Ketadex group than in the Ketofol group (P < 0.05). The recovery time was significantly less in the Ketofol group (41.85 ± 7.03 minutes) than in the Ketadex group (55.12 ± 7.55 minutes; P < 0.001). Conclusions: The addition of the low-dose ketamine to propofol and dexmedetomidine did not result in any significant changes in the level of sedation, the incidence of adverse effects, and the endoscopist’s satisfaction; however, the recovery time was shorter in the propofol-ketamine combination than in the dexmedetomidine-ketamine combination.
“…The previous studies with the combination of dexmedetomidine-ketamine and midazolam-ketamine mainly focused on the sedation level provided by the combination. 10,11 Most studies also looked into the hemodynamic and respiratory variables and post-operative side effects. 12,13 Few studies focused on the sedation level and recovery time.…”
Background: The growing popularity of ambulatory anesthesia has led to the development of newer drug regimens and combinations. We decided to compare the effects of ketamine plus dexmedetomidine versus ketamine plus midazolam in procedural sedation.
Aims and Objectives: The present study aimed to compare the effects of ketamine plus dexmedetomidine versus ketamine plus midazolam on the adequacy of anesthesia, level of sedation and analgesia, hemodynamic and respiratory parameters, recovery time, and post-operative side effects in short surgical procedures.
Materials and Methods: Hundred adult patients were randomized into two groups: Group KD: A bolus dose of Dexmedetomidine 1 mcg/kg in 100 ml NS over 10 min and Group KM: A bolus dose of Midazolam 0.05 mg/kg in 100 ml NS over 10 min. Both groups received bolus dose of Ketamine 1 mg/kg at the start of the procedure. Level of sedation, adequacy of anesthetic technique, hemodynamic parameters, time for rescue analgesia, post-operative recovery time, and complications was measured.
Results: In Group KD 7 (14%) patients and in Group KM 13 (26%) patients had inadequate anesthesia. A significant reduction in pulse rate (P<0.001) was observed in Group KD as compared to Group KM. MAP between the two study groups showed a statistically significant reduction in Group KD as compared to Group KM (P<0.05). Time for first rescue analgesia was delayed in Group KD (70.20±14.35) compared to that of Group KM (49±4.73) (P=0.000). Four (8%) patients in Group KD and 11 (22%) patients in Group KM had post-operative nausea and vomiting.
Conclusion: Dexmedetomidine-ketamine combination is a good and safe alternative agent for procedural sedation in patients undergoing short surgical procedures.
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