Comparing The Effects of Ketamine-Midazolam Combination  and Propofol on Sedation-Related Adverse Events  and Quality of Magnetic Resonance Imaging in Pediatric Patients

Waleed Ahmed Niazi; Kaukab Majeed; Najam Us Saqib; Shahid Maqsood; Adil Zafar; Arooj Ahsan

doi:10.51253/pafmj.v74i4.9283

Authors

Waleed Ahmed Niazi Department of Anesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Kaukab Majeed Department of Anesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Najam Us Saqib Department of Anesthesia, Combined Military Hospital, Gilgit/National University of Medical Sciences (NUMS) Pakistan
Shahid Maqsood Department of Anesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Adil Zafar Department of Anesthesia, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan
Arooj Ahsan Department of Anesthesia, Combined Military Hospital Hyderabad /National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i4.9283

Keywords:

Ketamine, Magnetic resonance imaging, Midazolam, Propofol, Sedation

Abstract

Objective: To compare the effects of Ketamine-Midazolam and Propofol on the sedation related adverse events and quality of Magnetic Resonance Imaging in pediatric patients undergoing Magnetic Resonance Imaging under sedation.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Anesthesia, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2021.

Methodology: A total of 100 pediatric patients undergoing Magnetic Resonance Imaging under sedation were divided in to two groups, Group-A and Group-B of 50 patients each. Group-A received 1.5 mg/kg Ketamine and 0.1 mg/kg Midazolam and Group-B received 1.5mg/kg Propofol to achieve Ramsay sedation score ≥4. Bolus doses of O.50 to 1mg/kg Ketamine and 0.50- 1mg/kg Propofol were used to maintain Ramsay sedation score ≥4 during the Magnetic Resonance Imaging. Primary outcome was frequency of sedation related adverse events during Magnetic Resonance Imaging and in immediate post-sedation period. Secondary outcome was Quality of Magnetic Resonance Imaging.

Results: One (2%) patient in Ketamine-Midazolam-Group developed intraoperative hypotension versus 15(31.9) patients in Propofol -Group (p-value<0.001), which is significant. Other Intraoperative adverse effects were, bradycardia 1(2%) versus 7(14%), desaturation 0.00(0%) versus 11(23.9%), movement 4(8%) versus 3(6.4%) in Ketamine-Midazolam versus Propofol-Group with p-value of 0.020, <0.001 and 0.056 respectively. Two adverse effects seen in post-anesthesia care unit were nausea-vomiting and desaturation.

Conclusion: Ketamine-Midazolam is a better choice for sedation than Propofol due to cardiovascular stability without causing respiratory compromise and can be a useful alternative for sedation in unfamiliar environment like magnetic resonance imaging suite.

Downloads

Download data is not yet available.

References

Youn AM, Ko YK, Kim YH. Anesthesia and sedation outside of the operating room. Korean J Anesthesiol 2015; 68(4): 323-331. https://doi.org/10.4097/kjae.2015.68.4.323

Arthurs OJ, Sury M. Anaesthesia or sedation for paediatric MRI: advantages and disadvantages. Curr Opin Anesthesiol 2013; 26(4): 489-494.

https://doi.org/10.1097/ACO.0b013e3283620121

Lawson GR. Sedation of children for magnetic resonance imaging. Arch Dis Child 2000; 82(2): 150-153.

https://doi.org/10.1136/adc.82.2.150

Urman R, Gross WL, Philip B. Anesthesia outside of the operating room. Oxford University Press; 2011.

Artunduaga M, Liu CA, Morin CE, Serai SD, Udayasankar U, Greer MC, et al. Safety challenges related to the use of sedation and general anesthesia in pediatric patients undergoing magnetic resonance imaging examinations. Pediatr Radiol 2021; 51(5): 724-735.

https://doi.org/10.1007/s00247-021-05044-5

Jung SM. Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging. Yeungnam Univ J Med 2020; 37(3): 159-168.

https://doi.org/10.12701/yujm.2020.00171

Kang R, Shin YH, Gil NS, Kim KY, Yeo H, Jeong JS. A comparison of the use of propofol alone and propofol with midazolam for pediatric magnetic resonance imaging sedation–a retrospective cohort study. BMC Anesthesiol 2017; 17(1): 1-5. https://doi.org/10.1186/s12871-017-0431-2

Fonseca FJ, Ferreira L, Rouxinol-Dias AL, Mourão J. Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis. Braz J Anesthesiol 2023; 73(5): 641-664.

https://doi.org/10.1016/j.bjane.2021.12.002

Sebe A, Yilmaz HL, Koseoglu Z, Ay MO, Gulen M. Comparison of midazolam and propofol for sedation in pediatric diagnostic imaging studies. Postgrad Med 2014; 126(3): 225-230. https://doi.org/10.3810/pgm.2014.05.2770

Dala PG, Murray D, Cox T, McAllister J, Snider R. Sedation and aesthesia protocols used for magnetic resonance imaging studies in infants: provider and pharmacological considerations. Anesth Analg 2006; 103: 863-868.

Pershad J, Wan J, Anghelescu DL. Comparison of propofol with pentobarbital/midazolam/fentanyl sedation for magnetic resonance imaging of the brain in children. Pediatrics 2007; 120(3): e629-636.

https://doi.org/10.1542/peds.2006-3108

Boriosi JP, Eickhoff JC, Klein KB, Hollman GA. A retrospective comparison of propofol alone to propofol in combination with dexmedetomidine for pediatric 3T MRI sedation. Pediatr Anesth 2017; 27(1): 52-59.

https://doi.org/10.1111/pan.13041

Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR. Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology 2005; 103(3): 470-477. https://doi.org/10.1097/00000542-200509000-00007

Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg 2009; 108(3): 795-804.

https://doi.org/10.1213/ane.0b013e31818fc334

Acworth JP, Purdie D, Clark RC. Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation. Emerg Med 2001; 18(1): 39-45. https://doi.org/10.1136/emj.18.1.39

Dachs RJ, Innes GM. Intravenous ketamine sedation of pediatric patients in the emergency department. Ann Emerg Med 1997; 29(1): 146-150.

Gürcan HS, Ülgey AY, Gergin ÖÖ, Pehlivan SS, YILDIZ KM. Investigation of the effects of propofol/ketamine versus propofol/fentanyl on nausea vomiting administered for sedation in children undergoing magnetic resonance imaging: a prospective randomized double-blinded study.Turk J Med Sci 2021; 4: 2120-2126. https://doi.org/10.3906/sag-2009-98

Aycan I, Taseli Y, Temel H, Dinc B, Coskunfirat N. Magnetic Resonance Imaging under Sedation in Pediatric Patients: A Single-Institution Experience. J Child Sci 2021; e185-e192. https://doi.org/10.1055/s-0041-1731335

Uludağ Ö, Doğukan M, Kaya R, Tutak A, Dumlupınar E. Comparison of the Effects of Midazolam-Ketamine or Midazolam-Propofol Combinations on Hemodynamic Stability, Patient Comfort, and Post-anesthesia Recovery in Children Undergoing Sedation for Magnetic Resonance Imaging Procedures. Ain-Shams J Anesthesiol 2020; 12(1): 1-7. https://dx.doi.org/10.1186/s42077-019-0037-7