Akelma H et al, 2018: Comparison of Ketamine with Midazolam versus Ketamine with Fentanyl for Pediatric Extracorporeal Shock Wave Lithotripsy Procedure: A Randomized Controlled Study.
Akelma H, Kiliç ET, Salik F, Kaydu A.
Department of Anesthesiology, Diyarbakır Gazi Yasargil Research and Education Hospital, Diyarbakır, Turkey.
Department of Anesthesiology, Ümraniye Training and Research Hospital, Istanbul, Turkey.
Department of Anesthesiology, Karaman State Hospital, Karaman, Turkey.
Department of Anesthesiology, Diyarbakır Selahaddini Eyyübi State Hopital, Diyarbakır, Turkey.
Objectives: To compare the effects of ketamine-fentanyl (KF) and ketamine-midazolam (KM) combinations on hemodynamic parameters, recovery properties, pain, and side effects in pediatric patients undergoing extracorporeal shock wave lithotripsy (ESWL) procedure.
Methodology: In this double-blinded, randomized trial, 60 pediatric patients aged between 1 and 13 years with American Society of Anesthesiologists physical status Classes I and II, who scheduled for ESWL procedure, were included in the study. Patients were randomly divided into two groups: Group KM received 0.1 mg/kg of midazolam +1-1.5 mg/kg of ketamine and Group KF received 1 μg/kg of fentanyl +1-1.5 mg/kg of ketamine intravenously.
Results: There were similar demographic properties, recovery, and discharge times between groups. No statistically significant difference was found in peripheral oxygen saturation, mean and diastolic blood pressure, Ramsey sedation scores, modified Aldrete recovery scores, side effects, and recovery times (Group KM, 16.067 ± 1.2 min; Group KF, 19.46 ± 0.86 min) between groups (P > 0.05).
Conclusion: KF combination offers better hemodynamic properties, less side effects with lower visual analog scores, and face, legs, activity, cry, and consolability scores than KM in the pediatric ESWL procedure.
Anesth Essays Res. 2018 Apr-Jun;12(2):464-469. doi: 10.4103/aer.AER_44_18. FREE ARTICLE
SWL is an excellent procedure for stone removal in children. The major problem is related to the need of anesthesia and general anesthesia is commonly used. Alternative methods are desirable and from a comparison of a number of variables (VAS score, FLACC score, hemodynamics and side effects) the authors found that a combination of Ketamine + Fentanyl (KF) was superior to Ketamine + Midazolam (KM).
The dosages used: