Midazolam-ketamine combination for moderate sedation in upper GI endoscopy

Area of Science:

• Pediatric Gastroenterology
• Anesthesiology
• Sedation Pharmacology

Background:

• Effective sedation is crucial for pediatric upper gastrointestinal endoscopy (UGIE) to ensure patient comfort and procedural success.
• Optimizing sedation regimens in children requires balancing efficacy, safety, and patient experience.

Purpose of the Study:

• To compare the quality of sedation using three distinct regimens in pediatric patients undergoing UGIE.
• To evaluate the efficacy and safety of oral ketamine and intravenous midazolam compared to placebo and oral fentanyl.

Main Methods:

• A randomized study involving 150 pediatric patients undergoing UGIE.
• Three groups received different sedation: Group A (placebo + IV midazolam), Group B (oral ketamine + IV midazolam), and Group C (oral fentanyl + IV midazolam).
• Sedation depth and patient comfort were primary endpoints, with safety and recovery time also assessed.

Main Results:

• Group B (oral ketamine + IV midazolam) demonstrated significantly lower midazolam requirements.
• Patients in Group B experienced less distress during IV placement and parental separation, higher comfort, and greater endoscopist satisfaction.
• Group B showed a shorter recovery time, with all regimens proving safe and complications managed successfully.

Conclusions:

• Synergistic sedation with oral ketamine and IV midazolam is a safe and suitable option for pediatric UGIE.
• The oral route of ketamine administration may contribute to a higher incidence of vomiting compared to previous studies.
• This regimen offers advantages in terms of patient comfort, procedural ease, and recovery efficiency.