Ketamine

Propofol‐ketamine vs propofol‐fentanyl for sedation during pediatric upper gastrointestinal endoscopy

“…The major advantage of ketamine is that it usually preserves airway patency and respiratory function (20). In the present study, all episodes of hypoxemia were transient and no patient required bag/mask ventilation in either group.…”

“…Petrack et al. (20) analyzed all data on emergence reactions after ketamine published from 1990 to 1995 and showed that their incidence varies from 0% to 9% of patients. In this study, only one patient was apathetic and withdrawn in the emergence period.…”

“…It has been shown that the combination of ketamine with propofol eliminates this side effect of ketamine (15). Overall, 8.5% of pediatric patients given ketamine may develop emesis, usually late in the recovery phase (20). Green et al.…”

Prospective evaluation of adjunctive ketamine on sphincter of Oddi motility in humans

“…We routinely use meperidine, midazolam, and diazepam for conscious sedation in these patients and reserve adjunctive ketamine for those difficult to sedate. The drug has an excellent safety profile and achieves deeper level of sedation 6,19–21 . Moreover, unlike propofol, ketamine can be administered by an endoscopist without the need for an anesthesiologist.…”

“…Also, adjunctive ketamine reduces requirements for meperidine due to its synergistic effect 17,18 . In addition, ketamine dosing has a wide safety margin compared with benzodiazepine and narcotic agents 19–21 . These pharmacological characteristics render ketamine a potential alternative to droperidol in difficult‐to‐sedate patients 20,21 .…”