Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial

Propofol-cetamina versus dexmedetomidina-cetamina para sedação durante endoscopia digestiva alta em pacientes pediátricos: estudo clínico randomizado

Akram M. Ame, Azza M. Youssef, Hala S. El-Ozairy, Ahmed M. El-Hennawy

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Background and objectives
Day-case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes.

We enrolled 120 patients (2−7 years in age) and randomly assigned them into two groups. Each patient received IV ketamine at a dose of 1 in addition to either propofol (1 or dexmedetomidine (0.5 μ The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored.

There was no significant difference in hemodynamics between the groups. The Propofol-Ketamine (P-K) group showed significantly shorter recovery times than the Dexmedetomidine-Ketamine (D-K) group (21.25 min and 29.75 min respectively,p < 0.001). The P-K group showed more oxygen desaturation. Eleven and six patients experienced SpO2< 92% in groups P-K and D-K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D-K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P-K group, respectively (p =  0.001). The P-K group showed less post-procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction.

The P-K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D-K combination showed less need for additional doses.

Registration number
Clinical (NCT02863861).


Dexmedetomidine;  Propofol;  Sedation;  Endoscopy;  Pediatrics


Justificativa e objetivos
A sedação ambulatorial pediátrica é um desafio. A dexmedetomidina é um analgésico sedativo que não induz à depressão respiratória. Comparamos a dexmedetomidina ao propofol quando associados à cetamina para sedação durante endoscopia pediátrica, quanto ao tempo de recuperação e às alterações hemodinâmicas.

Foram recrutados 120 pacientes (2−7 anos de idade) que foram aleatoriamente alocados em dois grupos. Cada paciente recebeu cetamina IV na dose de 1, além de propofol (1 ou dexmedetomidina (0,5 μ Comparamos o tempo de recuperação. A hemodinâmica, saturação de oxigênio, necessidade de doses adicionais, complicações pós-operatórias e satisfação do endoscopista foram monitoradas.

Não houve diferença significante entre os grupos no que diz respeito à hemodinâmica. O grupo Propofol-Cetamina (P-C) apresentou tempos de recuperação significantemente mais curtos do que o grupo Dexmedetomidina-Cetamina (D-C) (21,25 min e 29,75 min respectivamente, p <  0,001). Observou-se frequência maior de dessaturação de oxigênio no grupo P-C. Onze e seis pacientes apresentaram SpO2 < 92% nos grupos P-C e D-C, respectivamente. Uma diferença significante foi observada em relação à necessidade de doses adicionais; 10% dos pacientes no grupo D-C precisaram de uma dose extra e 5% precisaram de duas doses extras, em comparação com 25% e 20% no grupo P-C, respectivamente (p = 0,001). O grupo P-C apresentou menos náuseas e vômitos após o procedimento. Não houve diferença estatisticamente significante entre os dois grupos em relação à satisfação do endoscopista.

A combinação P-C foi associada a tempo mais curto de recuperação na endoscopia digestiva alta pediátrica, enquanto a combinação D-C mostrou menor necessidade de doses adicionais.

Número de registro
Clinical (NCT02863861).


Dexmedetomidina;  Propofol;  Sedação;  Endoscopia;  Pediatria


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