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

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.

Keywords

• Ketamine, Magnetic resonance imaging, Midazolam, Propofol, Sedation