A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

Jenifer R Lightdale, Paul D Mitchell, Meghan E Fredette, Lisa B Mahoney, Steven E Zgleszewski, Lisa Scharff, Victor L Fox, Jenifer R Lightdale, Paul D Mitchell, Meghan E Fredette, Lisa B Mahoney, Steven E Zgleszewski, Lisa Scharff, Victor L Fox

Abstract

Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ketamine (n = 17) moved more (median 25% of procedure time versus 8%, P = .03) and required similar low levels of restraint (0.83% versus 0.25%, P = .4) as patients sedated with midazolam/fentanyl (n = 20). Age-adjusted analyses suggested that patients sedated with ketamine were comparably more quiet (P = .002). Conclusions. A pilot trial of ketamine at our institution was associated with episodes of laryngospasm. In addition, children sedated with ketamine moved and required restraint similarly to patients sedated with midazolam/fentanyl. Physician perceptions may be affected by the fact that children who received ketamine were less likely to vocalize distress.

Figures

Figure 1
Figure 1
Explanation of variables in the Ohio State University Behavioral Rating Scale (OSUBRS).
Figure 2
Figure 2
Analysis of covariance of percent time nonvocalizing on years of age, adjusted for sedation type. Ketamine sedation is represented by closed circles (●) and a solid regression line (—) while medazolam/fentanyl is represented by open circles (∘) and a dotted regression line (…). Ketamine sedation is associated with a greater percentage of time nonvocalizing compared with medazolam/fentanyl (P = .002), independent of the effect of age. The interaction of sedation type with age was not statistically significant (P = .31).

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