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

Abstract

Background: Upper gastrointestinal endoscopy in pediatric patients have increased and become more frequent. Selection of a sedative with hemodynamic stability, rapid onset, short action and few side effects is essential. Material and methods: 60 ASAI/II patients between the age of 2-12 yrs of both sexes undergoing upper gastrointestinal endoscopy randomly allocated into two groups, 30 patients each, all patients received ketamine 1 mg/kg intravenous, then group KD received dexmedetomidine 1 μg/kg bolus dose slowly IV and patients in Group KP received propofol 1 mg/kg as initial doses then top-up doses of 2-4 ml of the prepared solutions were given till RSS of ≥ 5. Hemodynamic parameters, total ketamine dose, time to RSS ≥ 5 and PADSS of 9-10, side effects and Parents’ and Endoscopists’ satisfaction were recorded. Results: HR was significantly lower in group KD at T1, T2 and T3, no significant difference as regard MAP, RR, SpO2 and time to achieve RSS and PADSS (p>0.05), significantly higher total ketamine dose in group KD than group KP (P=0.001), Parents’ and Endoscopists’ satisfaction was significantly higher in group KD than KP (p<0.05). Conclusion: Ketamine-dexmedetomidine for sedation in children during upper gastrointestinal endoscopy is an effective, reliable and safe alternative to ketamine-propofol without hemodynamic or respiratory drawbacks with comparable onset and recovery time.