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Efficacy and safety of midazolam and ketamine in paediatric upper endoscopy
Ahmet Basturk1, Reha Artan1, Aygen Yılmaz1
1Department of Paediatric Gastroenterology, Faculty of Medicine, Akdeniz University, Dumlupinar Bulvari-Campus 07059, Antalya, Turkey.
Insights
Intravenous midazolam and ketamine provide safe and effective sedation for pediatric upper endoscopy. This combination is well-tolerated, with most complications being minor and transient.
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Sedation Management
Background:
- Upper endoscopy in children requires effective sedation.
- Optimal sedation methods for pediatric gastrointestinal interventions are still being determined.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous midazolam and ketamine for sedation during pediatric upper endoscopy.
Main Methods:
- A study involving pediatric patients aged 3-18 years undergoing upper endoscopy.
- Administration of intravenous midazolam and ketamine for sedation.
- Monitoring of vital signs and recording of post-procedure adverse events.
Main Results:
- Hypoxia occurred in 9% of patients; mild hypertension in 14%, hypotension in 5%, tachycardia in 23%, and bradycardia in 8%.
- Common post-procedure complications included sore throat (24%), dizziness (24%), and diplopia (27%).
- Serious adverse events were rare, with 4% requiring supplemental oxygen.
Conclusions:
- Intravenous midazolam and ketamine sedation is a safe and effective option for pediatric upper endoscopy.
- The sedation regimen was generally well-tolerated by the pediatric population studied.
Background And Study Aim:
Upper endoscopy can be successfully carried out in children under deep sedation and anaesthesia. However, the best method of upper endoscopy for children who require gastrointestinal intervention has yet to be defined. The aim of this study is to investigate the efficacy and safety of the sedation induced by intravenous midazolam and ketamine during upper endoscopy in children.
Patients And Methods:
This study included patients ages 3-18years who had undergone upper endoscopy. All subjects received IV midazolam and ketamine. During the intervention, hypoxia, tachycardia, bradycardia, hypertension, and hypotension were recorded. After the intervention, euphoria, dysphoria, vertigo, visual problems (such as diplopia and nystagmus), and emergencies (such as arrhythmia, convulsion, and hallucination), among other findings, were recorded. Older children who were capable of expressing themselves were questioned to help determine these conditions.
Results:
The mean age of the study group was was 11.9±3.42years; 54% of the patients were females, and 46% were males. During the upper endoscopy, hypoxia occurred in 9% of patients, mild hypertension in 14%, hypotension in 5%, tachycardia in 23%, bradycardia in 8%, and flushing-urticaria in 2%. After the upper endoscopy, one of the most common complications was sore throat, which occurred in 24% of patients. Vomiting was observed in 14% of patients, dizziness in 24%, diplopia in 27%, euphoria in 3% (5 patients), dysphoria in 4%, and hallucination in 4%. Of the total patients, 4% required oxygen supply with a face mask.
Conclusion:
The results of our study showed that the use of IV midazolam and ketamine during upper endoscopy in children was safe and effective.
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