Remifentanil-ketamine vs. propofol-ketamine for sedation in pediatric patients undergoing colonoscopy: A randomized clinical trial

Feride Karacaer; Ebru Biricik; Murat Ilgı; nel; Çağ; atay Küçükbingöz; Mehmet Ağ; ı; n; Gökhan Tümgör; Yasemin Güneş; Dilek Özcengiz

doi:10.1016/j.bjane.2018.06.010

Scientific Article

Remifentanil-ketamine vs. propofol-ketamine for sedation in pediatric patients undergoing colonoscopy: A randomized clinical trial

Remifentanil-cetamina vs. propofol-cetamina para sedação em pacientes pediátricos submetidos à colonoscopia: ensaio clínico randômico

Feride Karacaer; Ebru Biricik; Murat Ilgı; nel; Çağ; atay Küçükbingöz; Mehmet Ağ; ı; n; Gökhan Tümgör; Yasemin Güneş; ; Dilek Özcengiz

http://dx.doi.org/10.1016/j.bjane.2018.06.010 Braz J Anesthesiol, vol.68, n6, p.597-604, 2018

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Abstract

Abstract Background and objectives: Pediatric patients frequently require deep sedation or general anesthesia for colonoscopy. This study was designed to compare the sedative efficacy of remifentanil-ketamine combination with propofol-ketamine combination in children undergoing colonoscopy. Methods: Seventy patients, between 2 and 16 years of age, scheduled for diagnostic colonoscopy were randomly allocated into two groups. Remifentanil-ketamine group received intravenous ketamine 2 mg.kg−1 and remifentanil 0.25 µg.kg−1 combination, followed by 0.1 µg.kg−1.min−1 remifentanil infusion. Propofol-ketamine group received intravenous propofol 1 and 2 mg.kg−1 ketamine combination, followed by 1 mg.kg−1.h−1 propofol infusion. In the case of children discomfort (cry, movement, and cough), remifentanil 0.1 µg.kg−1 in the remifentanil-ketamine group or propofol 0.5 mg.kg−1 in the propofol-ketamine group were administered to improve children discomfort. Despite the therapy given above, if children still experience discomfort, 1 mg.kg−1 of ketamine was administered as a rescue drug, regardless of the group. Ramsay sedation score, hemodynamic variables, drug requirements, gastroenterologists' satisfaction, colonoscopy duration, recovery time, and side effects were recorded throughout the procedure and the recovery period. Results: The percentage of patients with a Ramsay sedation score of 4 or higher during the procedure was 73.5 and 37.1% in remifentanil-ketamine and propofol-ketamine groups, respectively (p = 0.02). Systolic and diastolic blood pressure variables were significantly higher only after induction in the remifentanil-ketamine group than in the propofol-ketamine group (p = 0.015). Conclusion: Coadministration of ketamine with either remifentanil or propofol effectively and safely provides sedation and analgesia in children undergoing colonoscopy. Sedation scores were significantly better in remifentanil-ketamine group than in propofol-ketamine group.

Keywords

Outpatient, Remifentanil, Ketamine, Propofol, Children, Colonoscopy

Resumo

Resumo Justificativa e objetivos: Os pacientes pediátricos com frequência precisam de sedação profunda ou anestesia geral para colonoscopia. Este estudo foi desenhado para comparar a eficácia sedativa da combinação de remifentanil-cetamina e de propofol-cetamina em crianças submetidas à colonoscopia. Métodos: Setenta pacientes, entre 2-16 anos, programados para colonoscopia diagnóstica foram alocados randomicamente em dois grupos. O grupo remifentanil-cetamina recebeu a combinação de 2 mg.kg−1 de cetamina por via intravenosa e 0,25 µg.kg−1 de remifentanil; seguido de infusão de remifentanil (0,1 µg.kg−1.min−1). O grupo propofol-cetamina recebeu a combinação de 1 mg.kg−1 de propofol e 2 mg.kg−1 de cetamina; seguido de infusão de propofol (1 mg.kg−1.h−1). Em caso de desconforto das crianças (choro, movimento e tosse), remifentanil (0,1 µg.kg−1) seria administrado ao grupo remifentanil-cetamina ou propofol (0,5 mg.kg−1) ao grupo propofol-cetamina. A despeito da terapia acima citada, caso as crianças ainda sentissem desconforto, cetamina (1 mg.kg−1) seria administrada como fármaco de resgate, independentemente do grupo. Escore de sedação de Ramsay, variáveis hemodinâmicas, necessidade de medicamentos, satisfação dos gastroenterologistas, duração da colonoscopia, tempo de recuperação e efeitos colaterais foram registrados durante o procedimento e o período de recuperação. Resultados: O percentual de pacientes com escore 4 ou mais na escala de sedação de Ramsay durante o procedimento foi de 73,5% e 37,1% nos grupos remifentanil-cetamina e propofol-cetamina, respectivamente, (p = 0,02). As variáveis, pressão arterial sistólica e diastólica, foram significativamente maiores no grupo remifentanil-cetamina do que no grupo propofol-cetamina, mas somente após a indução (p = 0,015). Conclusão: A coadministração de cetamina com remifentanil ou propofol fornece sedação e analgesia de forma eficaz e segura em crianças submetidas à colonoscopia. Os escores de sedação foram significativamente melhores no grupo remifentanil-cetamina do que no grupo propofol-cetamina.

Palavras-chave

Paciente ambulatorial, Remifentanil, Cetamina, Propofol, Crianças, Colonoscopia

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Remifentanil-ketamine vs. propofol-ketamine for sedation in pediatric patients undergoing colonoscopy: A randomized clinical trial

Remifentanil-cetamina vs. propofol-cetamina para sedação em pacientes pediátricos submetidos à colonoscopia: ensaio clínico randômico

Feride Karacaer; Ebru Biricik; Murat Ilgı; nel; Çağ; atay Küçükbingöz; Mehmet Ağ; ı; n; Gökhan Tümgör; Yasemin Güneş; ; Dilek Özcengiz

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