Brief Article
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World J Gastroenterol. Aug 21, 2011; 17(31): 3630-3635
Published online Aug 21, 2011. doi: 10.3748/wjg.v17.i31.3630
Ketamine and midazolam sedation for pediatric gastrointestinal endoscopy in the Arab world
Mohamad-Iqbal S Miqdady, Wail A Hayajneh, Ruba Abdelhadi, Mark A Gilger
Mohamad-Iqbal S Miqdady, Pediatric Department, Medical School, Jordan University of Science and Technology, Irbid 3030, Jordan
Mohamad-Iqbal S Miqdady, Pediatric Institute, Sheikh Khalifa Medical City, managed by Cleveland Clinic, Abu Dhabi, Abu Dhabi 51900, United Arab Emirates
Wail A Hayajneh, Pediatric Department, Medical School, Jordan University of Science and Technology, Irbid 3030, Jordan
Ruba Abdelhadi, Pediatric Department, University of Texas Health Science Center, San Antonia, TX, San Antonia, TX 78229, United States
Mark A Gilger, Pediatric Department, Baylor College of Medicine, Houston, TX 77030, United States
Author contributions: Miqdady MS, Hayajneh WA, Gilger MA and Abdelhadi R designed the study. Miqdady MS and Hayajneh WA collected and analyzed the data and wrote the manuscript. Gilger MA and Abdelhadi R analyzed the data and edited the manuscript.
Correspondence to: Mohamad-Iqbal S Miqdady, MD, Assistant Professor, Pediatric Institute, Sheikh Khalifa Medical City, managed by Cleveland Clinic, PO Box 51900, Abu Dhabi, United Arab Emirates. msmiqdady@yahoo.com
Telephone: + 971-50-1234283 Fax: +971-2-6104983
Received: August 30, 2010
Revised: January 24, 2011
Accepted: January 31, 2011
Published online: August 21, 2011
Abstract

AIM: To evaluate the safety and effectiveness of intravenous ketamine-midazolam sedation during pediatric endoscopy in the Arab world.

METHODS: A retrospective cohort study of all pediatric endoscopic procedures performed between 2002-2008 at the shared endoscopy suite of King Abdullah University Hospital, Jordan University of Science & Technology, Jordan was conducted. All children were > 1 year old and weighed > 10 kg with American Society of Anesthesiologists class 1 or 2. Analysis was performed in terms of sedation-related complications (desaturation, respiratory distress, apnea, bradycardia, cardiac arrest, emergence reactions), adequacy of sedation, need for sedation reversal, or failure to complete the procedure.

RESULTS: A total of 301 patients (including 160 males) with a mean age of 9.26 years (range, 1-18 years) were included. All were premedicated with atropine; and 79.4% (239/301) had effective and uneventful sedation. And 248 (82.4%) of the 301 patients received a mean dose of 0.16 mg/kg (range, 0.07-0.39) midazolam and 1.06 mg/kg (range, 0.31-2.67) ketamine, respectively within the recommended dosage guidelines. Recommended maximum midazolam dose was exceeded in 17.6% patients [34 female (F):19 male (M), P = 0.003] and ketamine in 2.7% (3 M:5 F). Maximum midazolam dose was more likely to be exceeded than ketamine (P < 0.001). Desaturation occurred in 37 (12.3%) patients, and was reversible by supplemental oxygen in all except 4 who continue to have desaturation despite supplemental oxygen. Four (1.3%) patients had respiratory distress and 6 (2%) were difficult to sedate and required a 3rd sedative; 12 (4%) required reversal and 7 (2.3%) failed to complete the procedure. None developed apnea, bradycardia, arrest, or emergence reactions.

CONCLUSION: Ketamine-midazolam sedation appears safe and effective for diagnostic pediatric gastrointestinal endoscopy in the Arab world for children aged > 1 year and weighing > 10 kg without co-morbidities.

Keywords: Pediatric endoscopy; Sedation; Ketamine; Arab