Midazolam–ketamine versus dexmedetomidine–ketamine combinations for anesthesia of pediatric patients undergoing cardiac catheterization

Abstract

Background: The aim of the current study was to compare the effects of midazolam-ketamine versus dexmedetomidine-ketamine combinations on hemodynamics, sedation level, and recovery period in pediatric patients undergoing cardiac catheterization for hemodynamic study. Patients and methods: Fifty pediatric patients undergoing cardiac catheterization for hemodynamic study were enrolled in the current study. Patients were randomly distributed to one of two equal groups: midazolamketamine group (group M) and dexmedetomidine-ketamine group (group D). The patients in group M received intravenous midazolam 0.1 mg/kg and ketamine 1 mg/kg as a bolus for induction, then received an intravenous midazolam infusion of 0.1 mg/kg/h and ketamine infusion of 1 mg/kg/h for maintenance whereas patients in group D received intravenous dexmedetomidine1μg/kg and ketamine 1 mg/kg as a bolus for induction, then received an intravenous dexmedetomidine infusion of 0.5 μg/kg/h and ketamine infusion of 1 mg/kg/h for maintenance. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SPO 2), and sedation scores were recorded. Recovery time, perioperative adverse events, and total ketamine consumption required for anesthesia maintenance were also recorded. Results: The HR was significantly lower in group D when compared with group M at 10, 20, and 30 min of the procedure with no significant difference as regards the MAP between the two study groups. There were no statistically significant differences between the two study groups in terms of Ramsay sedation scores. Ketamine consumption in group D was significantly lower than in group M. The recovery time was significantly shorter in group D when compared with group M. Conclusion: The dexmedetomidine-ketamine combination was superior to midazolam-ketamine combination because of less intraoperative ketamine consumption required for adequate intraoperative sedation and the shorter recovery time.

Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study)

“…The sample size was calculated using the STATA program, setting the type-1 error (α) at 0.05 and the power (1-β) at 0.8. the results from the previous study [11] showed that the ketamine consumption among the dexmedetomidine/ketamine group was 1.35 ± 0.75 mg/kg/h while among the midazolam/ ketamine group was 2.15 ± 1.43 mg/kg/h with a p-value less than 0.05. According to these values, a sample size of 35 cases per group is enough.…”

Ketamine, an Old–New Drug: Uses and Abuses

“…It was shown that ketamine in the combination with dexmedetomidine induced good efficacy and sedation, less intraoperative use of anesthetics, less arrhythmias and shorter recovery time in pediatric patients during cardiac catheterizations. Bolus injection which contained ketamine (1 mg/kg) and dexmedetomidine (1 mg/kg) was superior comparing to midazolam-ketamine combination in pediatric patients [36,37]. In adults, the common intravenous dose of ketamine for induction of anesthesia is 0.5-2 mg/kg, and the maintaince the dose is 1-2 mg/min.…”

Ketamine, an Old–New Drug: Uses and Abuses

“…It was shown that ketamine in combination with dexmedetomidine induced good efficacy and sedation, less intraoperative use of anesthetics, less arrhythmias and a shorter recovery time in pediatric patients during cardiac catheterizations. A bolus injection which contained ketamine (1 mg/kg) and dexmedetomidine (1 mg/kg) was superior compared to a midazolam–ketamine combination in pediatric patients [ 64 , 65 ]. In adults, for induction, ketamine is given intravenously at doses of 0.5–2 mg/kg, with a maintenance dose of 1–2 mg/min.…”