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Category: Volume 07 Issue 07 July 2019
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Title: Comarison of midazolam and ketamine versus propofol for procedural sedation during upper gastrointestinal endoscopy in children

Authors: Dr Pinky Gupta, Dr Suryalata Kookna, Dr Deepak Shivpuri, Dr Sunil Dutt Sharma, Dr Lalit Bharadia

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.79

Abstract

Introduction: Gastrointestinal (GI) endoscopy has become an essential modality for evaluation and treatment of GI diseases. It is an unpleasant procedure and difficult to perform on conscious children. Conscious sedation has been widely accepted as primary sedation for children undergoing these procedures. This study compares the effectiveness, safety and adverse events with midazolam - ketamine combination versus propofol used for sedation.

Design: Hospital based observational comparative Study

Material and Methods: 150 children aged 1 year to 18 years of either sex who underwent UGE for diagnostic purposes at Fortis Escorts Hospital were included. All the Monitoring and resuscitative equipment were checked prior to the procedural sedation, These included SOAPME (suction, oxygen, airway, pharmacy, monitors and equipment). Patients were divided into group 1(midazolam–ketamine combination) and 2 (propofol). The effectiveness of the sedation, complications during the procedure and sedation and recovery time were recorded

Results: Significantly lower mean arterial pressure was observed in group 2 as compared to group1 till 10 minutes. No statistical significant difference was seen in respiratory rate and oxygen saturation during the procedure. Vomiting was significantly more in group 1 as compared to group 2 (12% vs. 0%) while stridor was more in group 2. No significant difference was observed in both the groups in bradycardia, apnea and Significant difference was observed in sensorium in both groups till 8 minutes duration whereas it was no significant at 10 minutes. 

Conclusion: Procedural sedation is necessary during pediatric UGIE for analgesia, anxiolysis and amnesia. Propofol scored over midazolam + ketamine in terms of more rapid induction time, faster recovery and earlier discharge. Midazolam-ketamine scored over propofol in terms of less discomfort. 

Keywords: UGIE, Midazolam, Ketamine, Propofol, Pediatrics

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Corresponding Author

Dr Suryalata Kookna

Senior Resident, Department of Pediatrics, SMS Medical College and attached group of Hospitals, Jaipur