Safety and effectiveness of ketamine as a sedative agent for pediatric GI endoscopy

Background. The ideal sedation for children undergoing GI endoscopy remains elusive. After ketamine was introduced as a sedative agent in our GI procedure suite, improved sedation and reduced complications were observed. The aim of this study was to assess the safety and effectiveness of ketamine as a sedative agent for GI endoscopy in pediatric patients. Methods: A retrospective cohort study of 402 procedures (EGD, colonoscopy) was performed. Sedation-related complications were defined as hypoxia (oxygen saturation <95% by pulse oximetry), agitation, emergence reactions, stridor, laryngospasm, nausea, vomiting, aspiration, and muscle twitching, or any combination thereof. Sedation groups were defined as the following: Group I, midazolam and meperidine (n = 192); Group II, midazolam, meperidine, and ketamine (n = 82); and Group III, midazolam and ketamine (n = 128). Results: Group 1 (midazolam and meperidine) had the highest frequency of complications, most commonly hypoxia. Group 3 (midazolam and ketamine) had the lowest rate of complications (p = 0.001) and the highest rate of adequate sedation, although the difference was not significant (p = 0.07). Conclusions: The combination of midazolam and ketamine appears to provide safe and effective sedation for pediatric patients undergoing endoscopy.