A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

Lightdale, Jenifer R.; Mitchell, Paul D.; Fredette, Meghan E.; Mahoney, Lisa B.; Zgleszewski, Steven E.; Scharff, Lisa; Fox, Victor L.

doi:10.1155/2011/623710

Cited by 15 publications

(8 citation statements)

References 19 publications

(25 reference statements)

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“…45 This may be difficult to evaluate, partly because of different sedative protocols between hospitals, and synergistic effect should be considered if combination protocol is used. [46][47][48] Another possible reason is that there are a number of other factors that affect the requirement for sedatives, including biological factors such as genetic predisposition for individual pain thresholds and the requirement for analgesic drugs. 49 Some studies have revealed that using combination nonpharmacological interventions can decrease doses of sedative drugs.…”

Section: Discussionmentioning

confidence: 99%

A New Mobile Application to Reduce Anxiety in Pediatric Patients Before Bone Marrow Aspiration Procedures

Wantanakorn

Harintajinda

Chuthapisith

et al. 2018

Hospital Pediatrics

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OBJECTIVES: Insufficient preparation for children who are undergoing bone marrow aspiration can cause anxiety and negative outcomes. Nonpharmacological therapies have been proven to reduce fear in children who are undergoing painful procedures. We have therefore developed a mobile application to help reduce these patients’ anxiety by providing them with procedural information and coping skills. METHODS: This single-blinded, randomized controlled trial included 60 patients age 5 to 12 years old who were undergoing bone marrow aspiration procedures in Thailand that were conducted between May 2015 and May 2016. Sixty participants were randomly assigned to the intervention group (mobile application added to usual care) or the control group (usual care only). Preprocedural anxiety levels were evaluated by visual analog scales (child anxiety visual analog scale); this was repeated in the intervention group immediately after patients used the mobile application. On the day of the procedure, the patients’ cooperation levels were assessed by using the modified Yale Preoperative Anxiety Scale. The total amount of sedative drugs that were used was also recorded. The paired t test and the Wilcoxon signed rank test were used to analyze within-person change, whereas the t test and the Wilcoxon rank sum test were used for group comparisons. RESULTS: The child anxiety visual analog scale score of patients in the intervention group decreased significantly after they used the mobile application (P < .0012). The modified Yale Preoperative Anxiety Scale score of patients in the intervention group was significantly lower than that in the control group (P < .01). There was no difference in sedative use between the 2 groups. CONCLUSIONS: This mobile application possibly had effectiveness in routine use for reducing anxiety and increasing patients’ cooperation in bone marrow aspiration procedures.

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Section: Discussionmentioning

confidence: 99%

A New Mobile Application to Reduce Anxiety in Pediatric Patients Before Bone Marrow Aspiration Procedures

Wantanakorn

Harintajinda

Chuthapisith

et al. 2018

Hospital Pediatrics

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“…Reports of excessive muscle activity with KBRs have been described in other studies even in patients that appeared to be well sedated at onset of EGD. 18 Extended procedure time in some of our patients undergoing diagnostic and therapeutic endoscopy partly accounted for observed prolonged PACU recovery time. Two patients (ages 3 and 15) in the KBR group developed severe emergence reactions and hallucinations after EGD and were treated with Precedex.…”

Section: Discussionmentioning

confidence: 87%

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

Akingbola

Srivastav

Nguyen

et al. 2020

J Pediatr Intensive Care

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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

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“… Jamal et al, 2011 [ 12 ], Roback et al, 2005 [ 13 ], McQueen et al, 2009 [ 14 ], Urbain et al, 2000 [ 15 ], Lightdale et al, 2011 [ 16 ], Krick et al, 2013 [ 17 ], Margaret et al, 2021 [ 18 ] …”

Section: Reviewmentioning

confidence: 99%

Comparing the Safety and Effectiveness of Ketamine Versus Benzodiazepine/Opioid Combination for Procedural Sedation in Emergency Medicine: A Comprehensive Review and Meta-Analysis

Zaki¹,

Ibrahim²,

Osman³

et al. 2023

Cureus

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Procedural sedation is essential in the ED to conduct painful procedures effectively. Ketamine and benzodiazepines/opioids are commonly used, with ketamine providing adequate analgesia and preserving airway muscle tone. However, ketamine is associated with adverse effects while benzodiazepines/opioids can lead to respiratory depression. This study compares the safety and efficacy of ketamine and midazolam/fentanyl. Two search methods were used to identify studies related to our topic, including a database search and a manual search involving screening reference lists of articles retrieved by the database search. A methodological quality appraisal was conducted on the articles suitable for inclusion using Cochrane's risk of bias tool in the Review Manager software (Review Manager (RevMan) (Computer program). Version 5.4, The Cochrane Collaboration, 2020). Moreover, pooled analysis was performed using the Review manager software.The study analyzed 1366 articles, of which seven were included for analysis. Pooled data showed that ketamine and midazolam/fentanyl had similar effects on pain scores during procedures and sedation depth measured by the University of Michigan sedation scale. However, the Modified Ramsay Sedation Score showed significantly more profound sedation in the ketamine group. The only significant adverse events were vomiting and nausea, which had a higher incidence in the ketamine group.Our data suggest that ketamine is as effective as the midazolam/fentanyl combination for procedural sedation but is associated with higher incidences of adverse events. Therefore, midazolam/fentanyl can be recommended for procedural sedation in the ED. However, it should be provided in the presence of a physician comfortable with airway management due to high incidences of oxygen desaturation.

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A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

Cited by 15 publications

References 19 publications

A New Mobile Application to Reduce Anxiety in Pediatric Patients Before Bone Marrow Aspiration Procedures

A New Mobile Application to Reduce Anxiety in Pediatric Patients Before Bone Marrow Aspiration Procedures

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

Comparing the Safety and Effectiveness of Ketamine Versus Benzodiazepine/Opioid Combination for Procedural Sedation in Emergency Medicine: A Comprehensive Review and Meta-Analysis

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