Midazolam-ketamine versus dexmedetomidine-ketamine combinations for anesthesia of pediatric patients undergoing cardiac catheterization

Background: The aim of the current study was to compare the effects of midazolam-ketamine versus dexmedetomidine-ketamine combinations on hemodynamics, sedation level, and recovery period in pediatric patients undergoing cardiac catheterization for hemodynamic study. Patients and methods: Fifty pediatric patients undergoing cardiac catheterization for hemodynamic study were enrolled in the current study. Patients were randomly distributed to one of two equal groups: midazolam-ketamine group (group M) and dexmedetomidine-ketamine group (group D). The patients in group M received intravenous midazolam 0.1 mg/kg and ketamine 1 mg/kg as a bolus for induction, then received an intravenous midazolam infusion of 0.1 mg/kg/h and ketamine infusion of 1 mg/kg/h for maintenance whereas patients in group D received intravenous dexmedetomidine 1 mu g/kg and ketamine 1 mg/kg as a bolus for induction, then received an intravenous dexmedetomidine infusion of 0.5 mu g/kg/h and ketamine infusion of 1 mg/kg/h for maintenance. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SPO2), and sedation scores were recorded. Recovery time, perioperative adverse events, and total ketamine consumption required for anesthesia maintenance were also recorded. Results: The HR was significantly lower in group D when compared with group M at 10, 20, and 30 min of the procedure with no significant difference as regards the MAP between the two study groups. There were no statistically significant differences between the two study groups in terms of Ramsay sedation scores. Ketamine consumption in group D was significantly lower than in group M. The recovery time was significantly shorter in group D when compared with group M. Conclusion: The dexmedetomidine-ketamine combination was superior to midazolam-ketamine combination because of less intraoperative ketamine consumption required for adequate intraoperative sedation and the shorter recovery time.