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

Abstract

Both PK and PF combinations provided effective sedation in pediatric patients undergoing UGIE, but the PK combination resulted in stable hemodynamics and deeper sedation though more side effects.

Sedación, Seguridad y Utilidad de la Endoscopia Digestiva Alta en Pediatría

“…Los fármacos utilizados con mayor frecuencia para la sedación son benzodiazepinas, opiodes y ketamina, los que generalmente deben combinase para lograr el nivel de sedación deseada 4,8 . Recientemente se ha descrito con éxito el uso de propofol en diferentes procedimientos [9][10][11] . En un estudio prospectivo, Lightdale y cols, evaluaron el uso de propofol como agente para sedación en procedimientos endoscópicos en niños, sin embargo, al compararlo con agentes de uso común como midazolam y fentanilo, no observaron mayores beneficios 11 .…”

The safety and efficacy of remifentanil compared to fentanyl in pediatric endoscopy

“…Opioids have been reported to reduce the need for propofol, in addition to providing hemodynamic stability and increasing the performance of the endoscopist by providing ease of procedure (2,(6)(7)(8)(9)(10). Different combinations of these agents were studied in pediatric anesthesia literature (2,8,10,11).…”

“…Different combinations of these agents were studied in pediatric anesthesia literature (2,8,10,11). Fentanyl is a frequently used opioid agent proven to be efficient and safe for pediatric procedures, but its potency is intermediate and blood clearance is slow, which usually leads to much longer anesthesia duration than that of endoscopic procedures (2,8,10,11).…”

“…Different combinations of these agents were studied in pediatric anesthesia literature (2,8,10,11). Fentanyl is a frequently used opioid agent proven to be efficient and safe for pediatric procedures, but its potency is intermediate and blood clearance is slow, which usually leads to much longer anesthesia duration than that of endoscopic procedures (2,8,10,11). Remifentanil, which is a more potent agent with shorter duration of action, is frequently used in pediatric outpatient anesthesia in bone marrow aspiration, bronchoscopy, and cardiac catheterization, as well as in laser photocoagulation in premature infants (12)(13)(14)(15).…”

A Comparison of Ketamine-Dexmedetomidine versus Ketamine-Propofolfor Sedation in Children during Upper Gastrointestinal Endoscopy

“…Guidelines for pharmacological intervention were issued by the American Academy of Pediatric Committee on drugs to classify it into 3 categories: Conscious sedation, deep sedation and general anesthesia [2]. Because it is difficult to adjust the level of sedation especially in designated areas outside the operating rooms [3] and deep sedation is required in the pediatric age group to allow successful procedures [4], sedatives should be prescribed cautiously and as per body weight and titrated according to their therapeutic effects [5,6]. Children usually required high doses of these medications [7].…”