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Sedation with Midazolam - Ketamine Versus Propofol In Children Undergoing Magnetic Resonance Imaging: A Randomized Comparative Study

Author(s): Palak Garg, Padam Yadav, Susheel Kumar Saini, Priyadarashani, Ajay Kumar Saini, Seema Kumari

Objective

To evaluate the sedative effect, hemodynamics, respiratory effects, and incidence of complications of Propofol compared with Ketamine-Midazolam in children undergoing MRI examination.

Study design

In this prospective single-blinded randomized comparative study, conducted at the Department of Pediatrics, Artemis Hospital, Gurugram 100 children admitted for MRI on a daycare basis were included. Children were assigned in two groups randomly; 50 children in each group. One group was given Midazolam – Ketamine (Group A) while other was given Propofol (Group B) for sedation during MRI. The effectiveness of sedation during the procedure was evaluated according to the modified Ramsay sedation score (RSS). Mean arterial pressure (MAP), Heart rate (HR), peripheral oxygen saturation (SpO2), and respiratory rate (RR) were monitored continuously. All observed complications were also recorded.

Results

26% of patients in group A and 20.8% of patients in group B had no movement during the examination while 74% of patients in group A and 79.2% of patients in group B had minor movement. The mean induction dose of propofol administered to the patients of group B was significantly higher than the dose of ketamine administered to group A. The recovery time of groups A was significantly higher than group B. No patients developed major complications such as cardiac arrest, apnea or laryngospasm during the procedure.

Conclusions

Midazolam-Ketamine was found to be better than single-dose Propofol in children undergoing magnetic resonance imaging. Although Propofol had rapid awakening after MRI but it needed more induction dose. Maintenance of sedation is a problem with single-dose Propofol as patients might need additional doses.

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