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International Journal of Pediatrics
Volume 2011, Article ID 623710, 6 pages
http://dx.doi.org/10.1155/2011/623710
Clinical Study

A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

1Division of Gastroenterology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
2Children's Hospital Boston, Boston, MA 02115, USA
3University of Connecticut School of Medicine, Farmington, CT 06030, USA
4Boston University School of Medicine, Boston, MA 02118, USA

Received 16 November 2010; Revised 21 February 2011; Accepted 3 March 2011

Academic Editor: Mark A. Gilger

Copyright © 2011 Jenifer R. Lightdale et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ketamine ( 𝑛 = 1 7 ) moved more (median 25% of procedure time versus 8%, 𝑃 = . 0 3 ) and required similar low levels of restraint (0.83% versus 0.25%, 𝑃 = . 4 ) as patients sedated with midazolam/fentanyl ( 𝑛 = 2 0 ). Age-adjusted analyses suggested that patients sedated with ketamine were comparably more quiet ( 𝑃 = . 0 0 2 ). Conclusions. A pilot trial of ketamine at our institution was associated with episodes of laryngospasm. In addition, children sedated with ketamine moved and required restraint similarly to patients sedated with midazolam/fentanyl. Physician perceptions may be affected by the fact that children who received ketamine were less likely to vocalize distress.