Ketamine and midazolam sedation for pediatric gastrointestinal endoscopy in the Arab world

Table 1 Types of endoscopic procedures

	n (%)	Males	Females	Agerange (yr)	Meanage (yr)
Upper (U)	218 (72.4)	106	112	1-18	8.86
Lower (L)	16 (5.3)	14	2	1-16	9.09
U & L	67 (22.3)	40	27	2-18	10.89
Total	301	160	141

Table 2 Midazolam and ketamine doses

	Midazolam doses			Ketamine doses
	Allpatients	Males	Females	Allpatients	Males	Females
Min dose (mg/kg)	0.07	0.07	0.07	0.31	0.31	0.46
Max dose (mg/kg)	0.39	0.32	0.39	2.67	2.00	2.67
Mean dose (mg/kg)	0.16	0.15	0.16	1.06	1.03	1.08

Table 3 Sedative doses

	Midazolam doses (mg/kg)			Ketamine doses (mg/kg)
	Min	Max	Average	Min	Max	Average
Upper (U)	0.07	0.39	0.15	0.33	2.67	1.02
Lower (L)	0.07	0.32	0.17	0.60	1.84	1.12
U & L	0.08	0.27	0.18	0.31	2.11	1.17

Table 4 Distribution of patients receiving doses exceeding recommended max dose

Procedure	Midazolam		Ketamine
	n (%)	% per specificprocedure	n (%)	% per specificprocedure
Upper (U)	30 (57)	14	4 (50)	1.8
Lower (L)	5 (9)	31	0 (0)	0
U & L	18 (34)	27	4 (50)	6
Total	53 (17.6)		8 (2.7)

Table 5 Sedation failure

Sedative-related complications	n (%)
Desaturation < 94% in RA	37 (12.3)
Desaturation < 94% on supplemental O2	4 (1.3)
Respiratory distress	4 (1.3)
Apnea	0 (0.0)
Bradycardia	0 (0.0 )
Cardiac arrest	0 (0.0)
Emergence reaction	0 (0.0 )
Difficult to sedate/third medication	6 (2.0 )
Need for reversal medications	12 (4.0 )
Need for overnight stay	1 (0.3)
Failure to complete the procedure	7 (2.3 )

RA: Ruba abdelhadi.

Table 6 Effects of midazolam and ketamine dosing on development of desaturations

Procedure	Midazolam average dose (mg/kg)			Ketamine average dose (mg/kg)
	Patients with desaturation	Patients without desaturation	P value	Patients with desaturation	Patients without desaturation	P value
Upper (U)	0.26	0.14	< 0.001	2.2	0.86	< 0.001
Lower (L)	NA	0.17	NA	NA	1.12	NA
U &	0.24	0.168	< 0.001	2	1.01	< 0.001
n	37	264	NA	37	264	NA

NA: Not available.