Paediatric sedation during upper gastrointestinal endoscopy: Comparison of propofol + ketamine vs sodium thiopental + fentanyl
More details
Hide details
MD, Tehran University of Medical Sciences, Tehran, Iran
Anaesthesiology Department, Children’s Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
Online publication date: 2018-07-14
Publication date: 2018-12-10
Electron J Gen Med 2018;15(6):em99
Different drug regimens can be used for management of anxiety before endoscopy. This study aimed to compare the sedation effects of propofol+ketamine (PK) and sodium thiopental+fentanyl (TF) in children during upper gastrointestinal (UGI) endoscopy.

A triple-blind clinical trial was conducted on 88 children aged 2-12 years who were candidate for UGI endoscopy at Children’s Medical Centre, Tehran, Iran, during 2012-2013. It was administered propofol (2.1 mg/kg) + ketamine (1 mg/kg) and 100% oxygen in PK group, and thiopental (5 mg/kg) + fentanyl (1 mg/kg) in TF group. The haemodynamic status and degree of sedation by Ramsay’s criteria were measured.

The mean age in PK and TF groups was 92.2±38.2 and 98.6±49.5 months, respectively. The systolic blood pressure and heart rate significantly increased and decreased in PK and TF groups during the procedure, respectively. The frequency of Ramsay's Sedation Scales of 5 and 6 were respectively 72.7% and 27.3% for PF, and 54.5% and 45.5% for TF group (p=0.076).

Although both groups were similar in the degree of sedation, PK can be a more appropriate choice for sedation in children with special diseases undergoing endoscopy due to small changes in haemodynamic parameters and, consequently, their higher stability.

Mahajan L, Wyllie R, Steffen R, Kay M, Kitaoka G, Dettorre J, et al. The effects of a psychological preparation program on anxiety in children and adolescents undergoing gastrointestinal endoscopy. J Pediatr Gastroenterol Nutr. 1998;27(2):161-165.
Cote CJ, Wilson S, Work Group on S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: An update. Pediatrics. 2006;118(6):2587-2602. https://doi.org/10.1542/peds.2....
Hoffman GM, Nowakowski R, Troshynski TJ, Berens RJ, Weisman SJ. Risk reduction in pediatric procedural sedation by application of an American academy of pediatrics/American society of anesthesiologists process model. Pediatrics. 2002;109(2):236-243.
Hunter A, Mamula P. Bowel preparation for pediatric colonoscopy procedures. J Pediatr Gastroenterol Nutr. 2010;51(3):254-261. https://doi.org/10.1097/MPG.0b....
Turner D, Benchimol EI, Dunn H, Griffiths AM, Frost K, Scaini V , et al. Pico-salax versus polyethylene glycol for bowel cleanout before colonoscopy in children: A randomized controlled trial. Endoscopy. 2009;41(12):1038-1045. https://doi.org/10.1055/s-0029....
Phatak UP, Johnson S, Husain SZ, Pashankar DS. Two-day bowel preparation with polyethylene glycol 3350 and bisacodyl: A new, safe, and effective regimen for colonoscopy in children. J Pediatr Gastroenterol Nutr. 2011;53(1):71-74. https://doi.org/10.1097/MPG.0b....
Abbas MI, Nylund CM, Bruch CJ, Nazareno LG, Rogers PL. Prospective evaluation of 1-day polyethylene glycol-3350 bowel preparation regimen in children. J Pediatr Gastroenterol Nutr. 2013;56(2):220-224. https://doi.org/10.1097/MPG.0b....
Jibaly R, LaChance J, Lecea NA, Ali N, Weber JE. The utility of peg3350 without electrolytes for 2-day colonoscopy preparation in children. Eur J Pediatr Surg. 2011;21(5):318-321. https://doi.org/10.1055/s-0031....
Terry NA, Chen-Lim ML, Ely E, Jatla M, Ciavardone D, Esch S, et al. Polyethylene glycol powder solution versus senna for bowel preparation for colonoscopy in children. J Pediatr Gastroenterol Nutr. 2013;56(2):215-219. https://doi.org/10.1097/MPG.0b....
Jimenez-Rivera C, Haas D, Boland M, Barkey JL, Mack DR. Comparison of two common outpatient preparations for colonoscopy in children and youth. Gastroenterol Res Pract. 2009:518932. https://doi.org/10.1155/2009/5....
Wexner SD, Beck DE, Baron TH, Fanelli RD, Hyman N, Shen B, et al. A consensus document on bowel preparation before colonoscopy: Prepared by a task force from the American society of colon and rectal surgeons (ascrs), the American society for gastrointestinal endoscopy (asge), and the society of American gastrointestinal and endoscopic surgeons (sages). Gastrointest Endosc. 2006;63(7):894-909. https://doi.org/10.1016/j.gie.....
Hassall E, Lobe TE. Risks of oral sodium phosphate for pre-colonoscopy bowel preparation in children. Dis Colon Rectum. 2007;50(7):1099-1101. https://doi.org/10.1007/s10350....
Wexner SD, Rosen L, Baron TH. Risks of oral sodium phosphate for pre-colonoscopy bowel preparation in children: Response to drs. Hassall and lobe. Surg Endosc. 2007;21(6):1040-1041. https://doi.org/10.1007/s00464....
Pashankar DS, Uc A, Bishop WP. Polyethylene glycol 3350 without electrolytes: A new safe, effective, and palatable bowel preparation for colonoscopy in children. J Pediatr. 2004;144(3):358-362. https://doi.org/10.1016/j.jped....
Liacouras CA, Mascarenhas M, Poon C, Wenner WJ. Placebo-controlled trial assessing the use of oral midazolam as a premedication to conscious sedation for pediatric endoscopy. Gastrointest Endosc. 1998;47(6):455-460.
Paspatis GA, Charoniti I, Manolaraki M, Vardas E, Papanikolaou N, Anastasiadou A, et al. Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: A prospective, randomized study. J Pediatr Gastroenterol Nutr. 2006;43(2):195-199. https://doi.org/10.1097/01.mpg....
Fishbein M, Lugo RA, Woodland J, Lininger B, Linscheid T. Evaluation of intranasal midazolam in children undergoing esophagogastroduodenoscopy. J Pediatr Gastroenterol Nutr. 1997;25(3):261-266.
Thakkar K, El-Serag HB, Mattek N, Gilger MA. Complications of pediatric egd: A 4-year experience in peds-cori. Gastrointest Endosc. 2007;65(2):213-221. https://doi.org/10.1016/j.gie.....
Tait AR, Malviya S. Anesthesia for the child with an upper respiratory tract infection: Still a dilemma? Anesth Analg. 2005;100(1):59-65. https://doi.org/10.1213/01.ANE....
Lightdale JR, Goldmann DA, Feldman HA, Newburg AR, DiNardo JA, Fox VL. Microstream capnography improves patient monitoring during moderate sedation: A randomized, controlled trial. Pediatrics. 2006;117(6):e1170-1178. https://doi.org/10.1542/peds.2....
Gilger MA, Jeiven SD, Barrish JO, McCarroll LR. Oxygen desaturation and cardiac arrhythmias in children during esophagogastroduodenoscopy using conscious sedation. Gastrointest Endosc. 1993;39(3):392-395.
Lightdale JR, Valim C, Mahoney LB, Sharon W, DiNardo J, Goldmann DA. Agitation during procedural sedation and analgesia in children. Clin Pediatr (Phila). 2010;49(1):35-42. https://doi.org/10.1177/000992....
Schwarz SM, Lightdale JR, Liacouras CA. Sedation and anesthesia in pediatric endoscopy: One size does not fit all. J Pediatr Gastroenterol Nutr. 2007;44(3):295-297. https://doi.org/10.1097/MPG.0b....
Vargo JJ, DeLegge MH, Feld AD, Gerstenberger PD, Kwo PY, Lightdale JR , et al. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastrointest Endosc. 2012;76(1):e1-25. https://doi.org/10.1016/j.gie.....
Wengrower D, Gozal D, Gozal Y, Meiri C, Golan I, Granot E, et al. Complicated endoscopic pediatric procedures using deep sedation and general anesthesia are safe in the endoscopy suite. Scand J Gastroenterol. 2004;39(3):283-286.
Barbi E, Gerarduzzi T, Marchetti F, Neri E, Verucci E, Bruno I , et al. Deep sedation with propofol by nonanesthesiologists: A prospective pediatric experience. Arch Pediatr Adolesc Med. 2003;157(11):1097-1103. https://doi.org/10.1001/archpe....
Amornyotin S, Aanpreung P, Prakarnrattana U, Chalayonnavin W, Chatchawankitkul S, Srikureja W. Experience of intravenous sedation for pediatric gastrointestinal endoscopy in a large tertiary referral center in a developing country. Paediatr Anaesth. 2009;19(8):784-791. https://doi.org/10.1111/j.1460....
Amornyotin S, Aanpreung P. Clinical effectiveness of an anesthesiologist-administered intravenous sedation outside of the main operating room for pediatric upper gastrointestinal endoscopy in thailand. Int J Pediatr. 2010. https://doi.org/10.1155/2010/7....
Lowrie L, Weiss AH, Lacombe C. The pediatric sedation unit: A mechanism for pediatric sedation. Pediatrics. 1998;102(3):E30.
Bassett KE, Anderson JL, Pribble CG, Guenther E. Propofol for procedural sedation in children in the emergency department. Ann Emerg Med. 2003;42(6):773-782. https://doi.org/10.1016/S01960....
Green SM, Krauss B. Propofol in emergency medicine: Pushing the sedation frontier. Ann Emerg Med. 2003;42(6):792-797. https://doi.org/10.1016/S01960....
Green SM, Krauss B. The semantics of ketamine. Ann Emerg Med. 2000;36(5):480-482. https://doi.org/10.1067/mem.20....
White TJ, 3rd, Siegle RL, Burckart GJ, Ramey DR. Rectal thiopental for sedation of children for computed tomography. J Comput Assist Tomogr. 1979;3(2):286-288.
Burckart GJ, White TJ, 3rd, Siegle RL, Jabbour JT, Ramey DR. Rectal thiopental versus an intramuscular cocktail for sedating children before computerized tomography. Am J Hosp Pharm. 1980;37(2):222-224.
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(10):983-988. https://doi.org/10.1111/j.1460....
Abu-Shahwan I, Mack D. Propofol and remifentanil for deep sedation in children undergoing gastrointestinal endoscopy. Paediatr Anaesth. 2007;17(5):460-463. https://doi.org/10.1111/j.1460....
Barbi E, Petaros P, Badina L, Pahor T, Giuseppin I, Biasotto E , et al. Deep sedation with propofol for upper gastrointestinal endoscopy in children, administered by specially trained pediatricians: A prospective case series with emphasis on side effects. Endoscopy. 2006;38(4):368-375. https://doi.org/10.1055/s-2005....
Borgeat A, Popovic V, Meier D, Schwander D. Comparison of propofol and thiopental/halothane for short-duration ent surgical procedures in children. Anesth Analg. 1990;71(5):511-515.
Larsson S, Asgeirsson B, Magnusson J. Propofol-fentanyl anesthesia compared to thiopental-halothane with special reference to recovery and vomiting after pediatric strabismus surgery. Acta Anaesthesiol Scand. 1992;36(2):182-186.
Motamed F, Aminpour Y, Hashemian H, Soltani AE, Najafi M, Farahmand F. Midazolam-ketamine combination for moderate sedation in upper gi endoscopy. J Pediatr Gastroenterol Nutr. 2012;54(3):422-426. https://doi.org/10.1097/MPG.0b....
Journals System - logo
Scroll to top