Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.09.006
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

Downloads: 0
Views: 11

Abstract

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.

Methods
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 mg.kg-1 in addition to either propofol (1 mg.kg-1) or dexmedetomidine (0.5 μg.kg-1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored.

Results
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.

Conclusions
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 trials.gov (NCT02863861).

Keywords

Dexmedetomidine;  Propofol;  Sedation;  Endoscopy;  Pediatrics

Resumo

Resumo
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.

Métodos
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 mg.kg-1, além de propofol (1 mg.kg-1) ou dexmedetomidina (0,5 μg.kg-1). Comparamos o tempo de recuperação. A hemodinâmica, saturação de oxigênio, necessidade de doses adicionais, complicações pós-operatórias e satisfação do endoscopista foram monitoradas.

Resultados
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.

Conclusões
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 trials.gov (NCT02863861).

Palavras-chave

Dexmedetomidina;  Propofol;  Sedação;  Endoscopia;  Pediatria

References

1 J.W. Berkenbosch, P.C. Wankum, J.D. Tobias Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children Pediatr Crit Care Med., 6 (2005), pp. 435-439

2 N. Celik, E. Bombacı, S. Colakoğlu, et al. Comparison of haemodynamic effects of propofol-ketamine and propofol-fentanyl anaesthesia J Kartal Training Res Hospital., 11 (2000), pp. 801-804

3 P. Chang, D. Warren, G. Joubert, et al. Use of propofol sedation in paediatric emergency department J Paediatr Child Health., 8 (2003), pp. 511-512

4 M.A. Ramsay, T.M. Savege, B.R. Simpson, et al. Controlled sedation with alphaxalone–alphadolone BMJ., 22 (1974), pp. 656-659

5 P. Mogane Is blood pressure measurement important in children? South African Family practice, 55 (2013), pp. s36-39

6 R. Ringland, S. Early Conscious sedation: documenting the procedure J Emerg Nurs., 23 (1997), pp. 611-617

7 J. Aono, W. Ueda, K. Mamiya, et al. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys Anesthesiology., 87 (1997), pp. 1298-1300

8 Z. Tosun, R. Aksu, G. Guler, et al. Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy Paediatr Anaesth., 17 (2007), pp. 983-988

9 Ö Yağan, R.H. Karakahya, N Taş, et al. Comparison of dexmedetomidine versus ketamine-propofol combination for sedation in cataract surgery Turk J Anaesthesiol Reanim., 43 (2015), pp. 84-90

10 D.G. Canpolat, A. Esmaoglu, Z. Tosun, et al. Ketamine-propofol vs ketamine-dexmedetomidine combinations in pediatric patients undergoing burn dressing changes J Burn Care Res., 33 (2012), pp. 718-722

11 AS Hasanin, AM. Sira Dexmedetomidine versus propofol for sedation during gastrointestinal endoscopy in paediatric patients Egypt J Anaesth., 30 (2014), pp. 21-26

12 J. Dawes, D. Myers, M. Gorges, et al. Identifying a rapid bolus dose of dexmedetomidine (ED 50) with acceptable hemodynamic outcomes in children Paediatr Anaesth., 24 (2014), pp. 1260-1267

13 P. Ravipati, P.N. Reddy, C. Kumar, et al. Dexmedetomidine decreases the requirement of ketamine and propofol during burns debridement dressings Indian J Anesth., 58 (2014), pp. 138-142

14 H. Fang, L. Yang, X. Wang, et al. Clinical efficacy of dexmedetomidine versus propofol in children undergoing magnetic resonance imaging: a meta-analysis Inter J Clin Experimental Med., 8 (2015), pp. 11881-11889

15 J.A. Vázquez Reta, M.C. Jiménez Ferrer, A. Colunga Sánchez, et al. Midazolam versus dexmedetomidine for sedation for upper gastro-intestinal endoscopy Rev Gastroenterol Mex., 76 (2011), pp. 13-18

16 S. Koruk, A. Mirak, R. Gul, et al. Dexmedetomidine-Ketamine and Midazolam-Ketamine combinations for sedation in pediatric patients undergoing extracorporeal shock wave lithotripsy: a randomized prospective study J Anesth., 24 (2010), pp. 858-863

17 S. Malviya, T. Voepel Lewis, O.P. Eldevik, et al. Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes Br J Anaesth, 84 (2000), pp. 743-748

18 K. Thakkar, H.B. El Serag, N. Mattek, et al. Complications of pediatric EGD: a 4-year experience in PEDS-CORI Gastrointestinal Endoscopy., 65 (2007), pp. 213-221

19 J.E. Hall, T.D. Ulrich, J.A. Barney, et al. Sedative, amnestic and analgesic properties of small-dose dexmedetomidine infusions Anesth Analg, 90 (2000), pp. 699-705

20 N Bhana, KL Goa, KJ McClellan Dexmedetomidine Drugs., 59 (2000), pp. 263-268

21 S. Dial, P. Silver, K. Bock, et al. Pediatric sedation for procedures titrated to desired degree of immobility results in unpredictable depth of sedation Pediatr Emerg Care., 17 (2001), pp. 414-420

22 A.G. Usher, R.A. Kearney, B.C. Tsui Propofol total intravenous anesthesia for MRI in children Paediatr Anaesth., 15 (2005), pp. 23-28

23 MM Mogahed, ER. Salama A comparison of Ketamine-Dexmedetomidine versus Ketamine-Propofol for sedation in children during upper gastrointestinal endoscopy J Anesth Clin Res., 8 (2017), pp. 785-790

24 Y. Demiraran, E. Korkut, A. Tamer, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study Can J Gastroenterol., 21 (2007), pp. 25-29

25 A. Koroglu, H. Teksan, O. Sagir, et al. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging Anesth Analg., 103 (2006), pp. 63-67

26 G.S. Tomar, F. Singh, S. Ganguly, et al. Is dexmedetomidine better than propofol and fentanyl combination in minor day care procedures? A prospective randomized double-blind study Indian J Anaesth., 59 (2015), pp. 359-364

27 T.J. Ebert, J.E. Hall, J.A. Barney, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans Anesthesiology., 93 (2000), pp. 382-394

28 R. Ortega, C. Connor, S. Kim, et al. Monitoring ventilation with capnography N Engl J Med., 367 (2012), p. e27

5f7f0cbb0e8825bc42a212e4 rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections