Sami EKSERT, Mehmet Emin INCE, Necati BALAMTEKİN, Mustafa GULGUN

Safety of midazolam-propofol combination for sedation in pediatric patients undergoing gastrointestinal endoscopy

In recent years, the number of pediatric gastrointestinal procedures with anesthesia has increased. Purpose of this study is to evaluate the safety and efficacy of midazolam and propofol combination used in pediatric patients by anesthesiologists for upper and lower gastrointestinal system endoscopy and determine whether there is any difference in the sedation complications and recovery of anesthesia between age groups. The records of 273 patients aged between 3 and 17 who underwent upper and/or lower gastrointestinal system endoscopies were analyzed retrospectively. Complications, vital signs and modified Aldrete recovery scores were recorded. The patients were grouped as those under and over 5 years of age for comparison. There was no significant difference in the rate of complications between age groups (p =0.42, p=0.72). The rate of attained recovery for patients under 5 years of age and over 5 years of age were statistically significant at the 5th (p=0.014). The present study demonstrates that deep sedation with propofol and midazolam combination for pediatric elective esophagogastroduodenoscopies are provided safely by anesthesiologist with close monitoring. Patients under 5 years of age tend to recover more slowly from the drug effects. Thus, we recommend closer follow-up for children under 5 years of age in post-procedure period.

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1. Oh JE, Lee HJ, Lee YH. Propofol versus Midazolam for Sedation during Esophagogastroduodenoscopy in Children. Clin Endosc. 2013;46:368-72.

2. Chung HK, Lightdale JR. Gastrointest Endosc Clin N Am. Sedation and Monitoring in the Pediatric Patient during Gastrointestinal Endoscopy. 2016 Jul;26(3):507-25

3. Van Beek EJ, Leroy PL. Safe and effective procedural sedation for gastrointestinal endoscopy in children. J Pediatr Gastroenterol Nutr. 2012;54:171-85.

4. Xiao D, Wang F, Wang X, et al. Propofol combined with midazolam intravenous sedation anesthesia in pediatric upper gastrointestinal endoscopy. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009;34:595-8.

5. Paspatis GA, Manolaraki M, Xirouchakis G, et al. Synergistic sedation with midazolam and propofol versus midazolam and pethidine in colonoscopies: a prospective, randomized study. Am J Gastroenterol 2002;97:1963-7.

6. Reimann FM, Samson U, Derad I, et al. Synergistic sedation with low-dose midazolam and propofol for colonoscopies. Endoscopy. 2000;32:239-44.

7. Cohen S, Glatstein MM, Scolnik D, et al. Propofol for pediatric colonoscopy: the experience of a large, tertiary care pediatric hospital. Am J Ther. 2014;21:509-11.

8. Bedirli N, Egritas O, Cosarcan K, et al. A comparison of fentanyl with tramadol during propofol-based deep sedation for pediatric upper endoscopy. Paediatr Anaesth. 2012;22:150-55.

9. Eberl S, Polderman JA, Preckel B, et al. Is “really conscious” sedation with solely an opioid an alternative to every day used sedation regimes for colonoscopies in a teaching hospital? Midazolam/fentanyl, propofol/alfentanil, or alfentanil only for colonoscopy: a randomized trial. Tech Coloproctol. 2014;18:745-52.

10. Fabbri LP, Nucera M, Marsili M, et al. Ketamine, propofol and low dose remifentanil versus propofol and remifentanil for ERCP outside the operating room: is ketamine not only a “rescue drug”? Med Sci Monit. 2012;18:Cr575-80.

11. Motamed F, Aminpour Y, Hashemian H, et al. Midazolam-ketamine combination for moderate sedation in upper GI endoscopy. J Pediatr Gastroenterol Nutr. 2012;54:422-6.

12. Alletag MJ, Auerbach MA, Baum CR. Ketamine, propofol, and ketofol use for pediatric sedation. Pediatr Emerg Care. 2012; 28: 1391-1395; quiz 1396-8.

13. Coulter FL, Hannam JA, Anderson BJ. Ketofol simulations for dosing in pediatric anesthesia. Paediatr Anaesth. 2014;24:806-12.

14. Vardi A, Salem Y, Padeh S, et al. Is propofol safe for procedural sedation in children? A prospective evaluation of propofol versus ketamine in pediatric critical care. Crit Care Med. 2002;30:1231-6.

15. Kapklein MJ, Slonim AD. Ketamine vs. propofol: how safe is safe enough? Crit Care Med. 2002;30:1384-6.

16. Ghane MR, Javadzadeh HR, Mahmoudi S, et al. Intramuscular compared to intravenous midazolam for paediatric sedation: A study on cardiopulmonary safety and effectiveness. Afr J Paediatr Surg. 2014;11:219-24.

17. Rafeey M, Ghojazadeh M, Feizo Allah Zadeh H, et al. Use of oral midazolam in pediatric upper gastrointestinal endoscopy. Pediatr Int. 2010;52:191-5.

18. Verhage J, Mulder CJ, Willekens FL. Intravenous midazolam sedation in pediatric diagnostic upper digestive endoscopy. A prospective study in a general hospital. Rom J Gastroenterol. 2003;12:273-6.

19. Searle NR, Sahab P. Propofol in patients with cardiac disease. Can J Anaesth. 1993;40:730-47.

20. Wehrmann T, Kokabpick S, Lembcke B, et al. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointest Endosc. 1999;49:677-83.

21. Disma N, Astuto M, Rizzo G, et al. Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children. Eur J Anaesthesiol. 2005;22:848-52.

22. Ko KH, Hahm KB. Harmony of Duet over Solo: Use of Midazolam or Propofol for Sedative Endoscopy in Pediatric Patients. Clin Endosc. 2013;46:311-2