Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial
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 hemod...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-11-01
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| Series: | Brazilian Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001420301573 |
| _version_ | 1811201154619539456 |
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| author | Akram M. Amer Azza M. Youssef Hala S. El-Ozairy Ahmed M. El-Hennawy |
| author_facet | Akram M. Amer Azza M. Youssef Hala S. El-Ozairy Ahmed M. El-Hennawy |
| author_sort | Akram M. Amer |
| collection | DOAJ |
| description | 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 intravenous (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 and 29.75 minutes, respectively, p < 0.001). The P-K group showed more oxygen desaturation. Eleven and 6 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). 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 intravenosa (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 e 29,75 minutos, respectivamente, p < 0,001). Observou-se frequência maior de dessaturação de oxigênio no grupo P-C. Onze e 6 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). |
| first_indexed | 2024-04-12T02:17:04Z |
| format | Article |
| id | doaj.art-c2b4f8238c8449f6abf22151453d7738 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-04-12T02:17:04Z |
| publishDate | 2020-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-c2b4f8238c8449f6abf22151453d77382022-12-22T03:52:14ZengElsevierBrazilian Journal of Anesthesiology0104-00142020-11-01706620626Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trialAkram M. Amer0Azza M. Youssef1Hala S. El-Ozairy2Ahmed M. El-Hennawy3Corresponding author.; Ain-Shams University, Faculty of Medicine, Department of Anaesthesiology, Intensive Care, and Pain Management, Abbasia, Cairo, EgyptAin-Shams University, Faculty of Medicine, Department of Anaesthesiology, Intensive Care, and Pain Management, Abbasia, Cairo, EgyptAin-Shams University, Faculty of Medicine, Department of Anaesthesiology, Intensive Care, and Pain Management, Abbasia, Cairo, EgyptAin-Shams University, Faculty of Medicine, Department of Anaesthesiology, Intensive Care, and Pain Management, Abbasia, Cairo, EgyptBackground 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 intravenous (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 and 29.75 minutes, respectively, p < 0.001). The P-K group showed more oxygen desaturation. Eleven and 6 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). 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 intravenosa (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 e 29,75 minutos, respectivamente, p < 0,001). Observou-se frequência maior de dessaturação de oxigênio no grupo P-C. Onze e 6 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).http://www.sciencedirect.com/science/article/pii/S0104001420301573DexmedetomidinaPropofolSedaçãoEndoscopiaPediatria |
| spellingShingle | Akram M. Amer Azza M. Youssef Hala S. El-Ozairy Ahmed M. El-Hennawy Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial Brazilian Journal of Anesthesiology Dexmedetomidina Propofol Sedação Endoscopia Pediatria |
| title | Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial |
| title_full | Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial |
| title_fullStr | Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial |
| title_full_unstemmed | Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial |
| title_short | Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients: a randomized clinical trial |
| title_sort | propofol ketamine versus dexmedetomidine ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients a randomized clinical trial |
| topic | Dexmedetomidina Propofol Sedação Endoscopia Pediatria |
| url | http://www.sciencedirect.com/science/article/pii/S0104001420301573 |
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