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

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 = 17) moved more (median 25% of procedure time versus 8%, P = .03) and required similar low levels of restraint (0.83% versus 0.25%, P = .4) as patients sedated with midazolam/fentanyl ( n = 20). Age-adjusted analyses suggested that patients sedated with ketamine were comparably more quiet ( P = .002). 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.