Oral Ketamine or Nasal Midazolam for Sedation in Pediatric Upper Gastrointestinal Endoscopy

Abstract

Background: There is no agreement on the route of administration and the drug of choice for providing adequate sedation for pediatric invasive procedures. Objectives: We compared the utility, safety, and sedation effects of intranasal midazolam and oral ketamine. Materials & Methods: This double-blind clinical trial was performed on 100 children aged 2 to 14 years who were candidates for upper gastrointestinal (GI) endoscopy. Patients were randomly assigned to two groups: ketamine (4 mg/kg orally) and midazolam (0.1 mg/ kg intranasal). Sedation score, fear levels, children’s behavior at the time of separation from parents, and vital signs were recorded. Results: Higher systolic blood pressure was seen in children who received ketamine (P=0.012) and lower arterial oxygen saturation in the midazolam group (P=0.023). Also, the level of sedation showed no significant difference between the groups. Conclusion: Based on the results, administering oral ketamine or intranasal midazolam before endoscopy induced a similar sedation score in children. Also, both methods could be safe and non-invasive modalities for sedation.