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Ketamine-Fentanyl Versus Ketamine-Midazolam for Sedation in Children Undergoing Flexible Fiber-optic Bronchoscopy -

Gopika Ramesh1, Golla Ramakrishna1, Ketan Kumar1

  • 1Department of Pediatrics, AIIMS Bhubaneswar, Odisha, India.

Indian Journal of Pediatrics
|January 6, 2026
PubMed

Insights

The ketamine-fentanyl combination did not significantly reduce severe cough episodes during pediatric flexible fiberoptic bronchoscopy (FOB) compared to ketamine-midazolam. Post-hoc analysis suggested a potential benefit, with no increased adverse events observed.

Area of Science:

  • Pediatric Anesthesiology
  • Respiratory Medicine
  • Procedural Sedation

Background:

  • Flexible fiberoptic bronchoscopy (FOB) is a common pediatric procedure.
  • Coughing during FOB can complicate the procedure and patient recovery.
  • Optimizing sedation regimens is crucial for pediatric procedural success.

Purpose of the Study:

  • To compare the efficacy of ketamine-fentanyl (KF) versus ketamine-midazolam (KM) in reducing severe cough episodes during pediatric FOB.
  • To evaluate the safety profile of KF compared to KM in this patient population.

Main Methods:

  • A randomized controlled trial enrolled 75 children aged 6 months to 15 years undergoing FOB.
  • Participants received either intravenous ketamine and fentanyl (KF group) or ketamine and midazolam (KM group).
  • Video recordings were reviewed by a blinded observer to quantify severe cough episodes.

Main Results:

  • The ketamine-fentanyl group showed a trend towards fewer severe cough episodes (median 1 vs. 3), but this was not statistically significant (P=0.054).
  • Post-hoc analysis revealed a significantly lower frequency of severe cough episodes per minute in the KF group (P=0.008).
  • No significant differences were observed in sedation depth, procedure scores, need for additional sedation, or adverse events, including bradycardia, hypotension, or apnea.

Conclusions:

  • The ketamine-fentanyl combination did not achieve statistical significance in reducing severe cough episodes during pediatric FOB compared to ketamine-midazolam.
  • Post-hoc findings suggest a potential benefit of ketamine-fentanyl for cough suppression.
  • The KF combination was found to be safe, with no increase in adverse events.
Abstract

Keywords:
OpioidsPediatric bronchoscopyProcedural sedation

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