Propofol-ketamine versus propofol-tramadol sedation in children undergoing gastrointestinal endoscopy

Abstract

Numerous combinations of drugs are used for sedation in upper gastrointestinal endoscopies. The aim of this study was to compare the quality of two sedation regimens in upper gastrointestinal endoscopy performed on pediatric patients. After the study approval by the local ethics committee of Ondokuz Mayıs University Hospital, written informed consent was obtained from parents. Eighty patients between the ages of 1 and 18 were randomized into two groups. Group K (n=40) received propofol 1 mg/kg + 1 mg/kg ketamine intravenously. Group T (n=40) received propofol 1 mg/kg + 1 mg/kg tramadol intravenously. In both groups, additional propofol (0.5 mg/kg) was administrated when a patient showed signs of discomfort, in order to maintain a Ramsey Sedation Scale of 4 to 5. In Group K, additional propofol requirements were significantly lower compared to Group T (p=0.003). Group K had significantly higher sedation scores than Group T at 3rd min. (p=0.028) and 20th min. (p=0.015). Recovery time increased significantly in Group K (p=0.002). Although there was no difference between two groups concerning the propofol consumption, both groups required additional propofol and tramadol resulted in a shorter recovery time compared to ketamine.

Keywords

• Anesthesia Recovery Period
• Deep Sedation
• Digestive System Endoscopy
• Pediatric Nursing

References

1. American Society of Anesthesiologists Task Force on S, Analgesia by N-A. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96: 1004-17.
2. Bedirli N, Egritas O, Cosarcan K, Bozkirli F. A comparison of fentanyl with tramadol during propofol-based deep sedation for pediatric upper endoscopy. Paediatr Anaesth 2012; 22: 150-5.
3. Brecelj J, Trop TK, Orel R. Ketamine with and without midazolam for gastrointestinal endoscopies in children. J Pediatr Gastroenterol Nutr 2012; 54: 748-52.
4. Canpolat DG, Esmaoglu A, Tosun Z, Akın A, Boyaci A, Coruh A. Ketamine-propofol vs ketamine-dexmedetomidine combinations in pediatric patients undergoing burn dressing changes. J Burn Care Res 2012; 33: 718-22.
5. Chung HK, Lightdale JR. Sedation and Monitoring in the Pediatric Patient During Gastrointestinal Endoscopy. Gastrointest Endosc Clin N Am. 2016; 26: 507-25.
6. Damps M, Stołtny L, Siemek-Mitela J, Lekstan A, Krzych Ł, Kucewicz-Czech E. Comparison of propofol-ketamine versuspropofol-remifentanil in children anaesthetized for gastroscopy. Anaesthesiol Intensive Ther. 2019; 51: 262-267.
7. Green SM, Klooster M, Harris T, Lynch EL, Rothrock SG. Ketamine sedation for pediatric gastroenterology procedures. J Pediatr Gastroenterol Nutr 2001; 32: 26-33.
8. Guit JB, Koning HM, Coster ML, Niemeijer RP, Mackie DP. Ketamine as analgesic for total intravenous anaesthesia with propofol. Anaesthesia 1991; 46: 24-27.

9. Horeczko T and Mahmoud MA The sedation mindset: philosophy, science, and practice. 2016. Curr Opin Anaesthesiol 29 Suppl 1, 48-55
10. Karacaer F, Biricik E, Ilgınel M, Küçükbingöz Ç, Ağın M, Tümgör G, Güneş Y, Özcengiz D. Remifentanil-ketamine vs. propofol-ketamine for sedation in pediatric patients undergoing colonoscopy: A randomized clinical trial. Rev Bras Anestesiol. 2018; 68: 597-604.
11. Koruk S, Mizrak A, Gul R, Kilic E, Yendi F, Oner U. Dexmedetomidine-ketamine and midazolam-ketamine combinations for sedation in pediatric patients undergoing extracorporeal shock wave lithotripsy: A randomized prospective study. J Anesth 2010; 24: 858-63.
12. Kuzhively J and Pandit JJ Anesthesia and airway management for gastrointestinal endoscopic procedures outside the operating room. 2019. Curr Opin Anaesthesiol. 32, 517-522
13. Khurmi N, Patel , Kraus M, Trentman T. Pharmacologic Considerations for Pediatric Sedation and Anesthesia Outside the Operating Room: A Review for Anesthesia and Non-Anesthesia Providers. Paediatr Drugs 2017; 19: 435-446.
14. Langston WT, Wathen JE, Roback MG, Bajaj L. Effect of ondansetron on the incidence of vomiting associated with ketamine sedation in children: A double-blind, randomized, placebo-controlled trial. Ann Emerg Med 2008; 52: 30-4.
15. Lightdale JR, Mitchell PD, Fredette ME, et al.A pilot study of ketamine versus midazolam/fentanyl sedation in children undergoing gi endoscopy. Int J Pediatr 2011; 2011: 623710.
16. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974; 2: 656-9.
17. Roelofse JA. The evolution of ketamine applications in children. Paediatr Anaesth 2010; 20: 240-5.
18. Steward DJ. A simplified scoring system for the post-operative recovery room. Can Anaesth Soc J 1975; 22: 111-3.
19. Stogiannou D, Protopapas A, Protopapas A, Tziomalos K. Is propofol the optimal sedative in gastrointestinal endoscopy? Acta Gastroenterol Belg. 2018; 81: 520-524.
20. Tosun Z, Aksu R, Guler G,Esmaoglu A, Akin A, Aslan D, et al. Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy. Paediatr Anaesth 2007, 17, 983-8.
21. Van Beek EJ, Leroy PL. Safe and effective procedural sedation for gastrointestinal endoscopy in children. J Pediatr Gastroenterol Nutr 2012; 54: 171-85.
22. Watcha MF, Ramirez-Ruiz M, White PF, Jones MB, Lagueruela RG, Terkonda RP. Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy. Canadian J of Anaesth 1992; 39: 649-54.
23. Wathen JE, Roback MG, Mackenzie T, Bothner JP. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, emergency department trial. Ann Emerg Med 2000; 36: 579-88.