COMPARISON BETWEEN DEXMEDETOMIDINE-MIDAZOLAM, PROPOFOL AND KETAMINE USED FOR CHILDREN SCHEDULED FOR ENDOSCOPIC ESOPHAGEAL BALLOON DILATATION AFTER CORROSIVE ESOPHAGEAL STRICTURE

Background: Endoscopic procedures are frequently required for diagnosis and treatment of GIT diseases in children .The agent used for sedation in these procedures should be of rapid onset, short duration of action and safely administered with low risk of potential complications. The accidental ingestion of a corrosive substance is still a common cause of esophageal strictures in children in our country. The aim of this study is to compare the efficacy, safety, recovery characteristics and hemodynamics of exmedetomidine-midazolam combination with those of Propofol and ketamine in children undergoing post corrosive endoscopic esophageal balloon dilatation. Method: 60 children 2-10 years old suffering from post corrosive esophageal stricture proved by barium swallow came to endoscopy unit in the New Children University Hospital (Abo Elreesh) for regular dilatation sessions. Children were randomized into three equal groups. Group I ( dexmedetomidine- midazolam group n=20) where 0.05 mg /kg midazolam was administered followed by bolus of dexmedetomidine 2 μg/kg administered over 5 minutes, followed by 0.4 μ g/kg/h as continuous infusion of dexmedetomidine using a syringe pump. Group (propofol group, n=20) where bolus dose of propofol 1mg/kg was given over 5 minutes then continuous infusion of propofol 5 mg/kg /h using a syringe pump. Group (ketamine group, n=20) where 2mg/kg together with atropine 0.02 mg had been given intravenously. If any time unwanted movement occurred, the procedures stopped and increments of 0.5mg/kg ketamine administered. Heart rate, mean arterial blood pressure, respiratory rate, and oxygen saturation were recorded prior to sedation and every 5 minutes till discharge. The onset of sedation, Procedure time, recovery time, discharge time; postoperative need for analgesia were recorded, besides the incidence of adverse effects and unwanted movements during the procedure. Results: In group П the mean onset of sedation was significantly shorter than group I and insignificantly shorter than group Ш. There was significant hemodynamic effects in the first 25 minutes and more incidence of side effects in group П than the other two groups .There was more analgesia in group Ш than group I And both more than group П significantly. Conclusion: Dexmedetomidine-midazolam combination and ketamine had relatively more stable hemodynamic and respiratory profiles, with adequate postoperative analgesia and this renders them in superior position and the ketamine takes the advantage of quicker onset of sedation and rapid recovery than the dexmedetomidine-midazolam combination.