Table 2.
Summary of the included studies
| STUDY | STUDY DESIGN | COUNTRY | ANESTHESIA INDUCTION |
ANESTHESIA MAINTENANCE |
TOTAL PARTICIPANTS |
FOLLOW-UP DURATION |
MAIN INCLUSION CITERIA |
PRIMARY OUTCOMES |
CONCLUSION | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TOSUN2007 | prospective, randomized, double blinded | Turkey | Propofol/Ketamen | Propofol/fentanyl | propofol | 90 | 2 hours | ASA I-II, aged 1 to 16-year-old patients | "Heart rate (HR), systolic arterial pressure (SAP), peripheral oxygen saturation (SpO2), respiratory rate (RR), and Ramsey sedation scores" | the PK combination provided better tolerance of endoscope insertion and better hemodynamic stability but side effects were more frequent in this group. Restlessness during endoscopy was observed more often in the PF group than in the PK group. | |||
| AKBULUT et al. 2017) | prospective, randomized, single blinded | Turkey | Midozolam/ketamine | Fentanyl/propofol | Ketamine | propofol | 238 | N/E | patients who underwent UGE for diagnostic purposes | RSS |
-midazolam–ketamine combination were more comfortable than that in the fentanyl–propofol group during the procedure. -the recovery time was longer in the midazolam–ketamine group. -the fentanyl–propofol group was more comfortable in the recovery period in terms of complications." |
||
| PATINO 2015 | prospective, randomized | USA | Group IS (Sevoflurane) | Group IP-airway management with intubation and anesthetic maintenance with propofol | Group NA-native airway with oxygen supplementation by nasal cannula and maintenance with propofol. | N/E | 180 | N/E | children aged 1–12 years with ASA physical status I or II presenting for outpatient EGD | -incidence of respiratory complications: minor desaturation (SpO2 between 94% and 85%), severe desaturation (SpO2 < 85%), apnea, bronchospasm, aspiration, airway obstruction, laryngospasm, and trauma during airway manipulation. | -an increased incidence of respiratory complications in nonintubated patients maintained with propofol; endotracheal intubation was seen to greatly reduce the incidence of adverse airway events during EGD.-the general anesthesia with propofol and the native airway during EGD was associated with a higher incidence of respiratory complications, including minor desaturation, severe desaturation, inadequate anesthesia and apnea, compared with endotracheal intubation; no improvement in institutional efficiency was seen with avoidance of endotracheal intubation. | ||
| USTUN 2021 | prospective, randomized | Turkey | Ketamine/propofol | Tramadol/propofol | Propofol | 80 | N/E | ASA physical status I–II patients, ages 1 to 18 who were scheduled for upper gastrointestinal endoscopies (UGIE) | The heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), respiratory rate (RR), and Ramsay sedation scores | combination of tramadol-propofol result in a faster recovery without increase the rate of adverse effects. However, patients required additional propofol due to insufficient sedation, so tramadol should be considered for short procedures. | |||
| WANG 2022 | prospective, randomized, double-blinded | China | Group P (S-Ketamine 0 mg/kg) | Group S0.3 (S-Ketamine 0.3 mg/kg) | Group S0.5 (S-Ketamine 0.5 mg/kg) | Group S0.7 (S-Ketamine 0.7 mg/kg) | Propofol | 120 | N/E | School-aged children (6 to 12 years old) with ASA I or II and undergoing gastro duodenoscopy were enrolled. | smooth placement rate of first endoscope insertion. | -S-ketamine could improve the tolerance and the smooth placement rate during endoscope insertion, which was positively related to the dosage of S-ketamine.-combined administration of S-ketamine and propofol can increase the tolerance of school- aged children during endoscopic insertion. Moreover, the smooth placement rate during the frst endoscope insertion is positively correlated with the dose of S-ket- amine. S-ketamine administration at 0.7 mg.kg−1can maintain hemodynamic stability in children, reduce the number of additional propofol and the total amount of propofol, and improve endoscopist satisfaction. However, dizziness is the most common adverse event with 73.3% incidence and may prolong PACU stay. | |
| YAO 2021 | prospective, randomized | China | Lidocaine (1.5 mg/kg) | Control group (Saline) | lidocaine | saline | 40 | 60 min after the procedure | "children aged 5–12 years who were scheduled for colonoscopy" | propofol requirement, | intravenous lidocaine can be safely used in paediatric patients undergoing colonoscopy, reducing the required propofol by 35.5%. Awakening and recovery times were signifcantly reduced in the lidocaine group, as well as the number of involuntary body movements. Patients in the lidocaine group had signifcantly lower pain scores after colonoscopy than those in the control group. | ||
| YUAN 2022 | prospective, randomized, double-blinded, placebo | China | Group S (Saline) | Group L (Lidocaine) | Sufentanil | Propofol | 40 | N/E | children aged from 3 to 10 years undergoing colonoscopy under sedation were included in our study, | Intraoperative propofol and sufentanil requirements and the number of oxygen desaturation episodes (defined as peripheral capillary oxygen desaturation (SpO2) less than 95% and 90%). | adding i.v. lidocaine as an adjuvant drug could significantly reduce the propofol and sufentanil requirements for pediatric colonoscopy and at the same time, shorten the recovery time. | ||
| AMER 2020 | RCT | Egypt | Dexmedetomidine-ketamine | Propofol-ketamine | 120 | N/E | Patients with the ASA physical status I-II, between 2 and 7 years old who are scheduled for elective diagnostic upper gastrointestinal endoscopy | Hemodynamic variables including Heart Rate (HR), Mean Arterial Pressure (MAP), Respiratory Rate (RR) and Oxygen Saturation (SpO2), The incidence of significant hypotension, recovery time, dosage of anesthesia, post-procedure complications, and endoscopist satisfaction | Propofol-ketamine was superior in reducing recovery time for pediatric patients undergoing upper gastrointestinal endoscopy and is prefereable is short diagnostic procedures while Dexmedetomidine-ketamine required a lower dose so it is better in long procedures | ||||
| BRECELJ 2012 | RCT | Slovenia | Midazolam and Ketamine | Ketamine | Propofol | 201 | atleast 1 month | Patients between 1-19 years old suitable for IV anesthesia | Adverse events | The addition of midazolam to ketamine sedation proved to be safe with the ability to reduce the number of emergency events in the hospital | |||
| DAMPS 2019 | RCT | Poland | Propofol and Ketamine | Propofol and Remifentanil | Propofol | Propofol and Remifentanil | 90 | N/E | Children with ASA I who were enrolled for elective endoscopy of the upper gastrointestinal tract under general anaesthesia | respiratory and circulatory parameters, adverse events, waking time and the child’s condition post-operation | The addition of ketamine to propofol was superior in induction of anesthesia while the addition of remifentanil was superior in recovery and improving post-operative mood and both additions were safe | ||
| HAYES 2018 | Randomized, double-blind, four-arm trial | Canada | Ketamine 0 mg/kg | Ketamine 0.25 mg/kg | Ketamine 0.5 mg/kg | Ketamine 1 mg/kg | Propofol | 56 | N/E | Children aged 3-12 yr undergoing elective gastro-duodenoscopy | - ED50 of propofol - Mean arterial pressure - Incidence of nausea and visual disturbances | Ketamine at 0.5e1 mg kge1 reduces the dose of propofol required to provide general anaesthesia for gastro-duodenoscopy in children and may reduce the incidence of propofol-related changes in haemodynamics. | |
| KARACAER 2018 | Randomised, double blind | Turkey | Remifentanil and ketamine | Propofol and Ketamine | Remifentanil | Propofol | 70 | N/E | ASA I-II Children aged 2-16-years undergoing colonoscopy procedure with sedation | - To measure the efficacy of PK and RK combinations on RSSs | Coadministration of ketamine with either remifentanil or propofol effectively and safely provides sedation and analgesia in children undergoing colonoscopy. Sedation scores were significantly better in remifentanil-ketamine group than in propofol-ketamine group | ||
| KHODADAD 2016 | Randomised, double blind | Iran | 0.5 mg/kg Oral midazolam | 0.1 mg/kg IV midazolam | N/E | 120 | N/E | 1 to 16-year-old patients who require diagnostic upper endoscopy and the ASA class I and II. | - The assessment of the safety and efficacy of oral midazolam and intravenous midazolam in terms of vital signs, oxygen saturation, and adverse effects. | Oral or IV midazolam were not able to put most patients in deep sedation level | |||
| SIENKIEWICSZ 2015 | Blind randomized trial | Poland | atropine (10 mcg/kg) | alfentanyl (5 mcg/kg) | lignocaine (0.5 mg/kg) | midazolam (0.025 mg/kg). | propofol | Midazolam | 51 | 120 minutes after the procedure | Children at the age of 9–16 years, classified to the first or second class of the American Society of Anaesthesiologists’ physical status classification | level of pain, level of pain, Procedure memory | In children sedated for EGD, propofol is significantly better than midazolam at providing procedural amnesia and controlling behaviour during the procedure. |
| BEDIRLI 2012 | Randomised, double blind | Turkey | fentanyl (2 ug.Kg-1) with propofol (1.5 ug.Kg-1) | Tramadol (2 ug.Kg-1) with propofol (1.5 ug.Kg-1) | N/E | 80 | 5 minutes, 15 minutes, 20 minutes | patients with ASA I-II, aged 1–16 years, | changes in oxygen saturation, changes in sedation score, Adverse effects | Tramadol in pediatric patients undergoing UGIE provided sedation as efficient as fentanyl with a better hemodynamic and respiratory stability and provided a superior safety and tolerance in younger children. | |||
| RAFEEY 2010 | prospective, randomized | Iran | oral midazolam (0.5 mg/kg) | i.v. midazolam (0.05–0.1 mg/kg) | N/E | 61 | SpO2, HR, SAP, and RR were recorded just before the midazolam was introduced (T0m), 10 min after midazolam (T10m), during the procedure (Ten), and 10 min after removal of the endoscope (Ten10). | 61 consecutive children who underwent upper gastrointestinal endoscopy were prospectively included in the study (range, 1–16 years) | compare the safety and efficacy of oral versus i.v. midazolam in providing sedation for pediatric upper gastrointestinal (GI) endoscopy | Oral administration of midazolam is a safe and effective method of sedation that significantly reduces anxiety and improves overall tolerance for children undergoing esophagogastroduodenoscopy. | |||
| ALI 2004 | double-blind, randomized trial | USA | fentanyl (1 ¹g/kg) | meperidine (1 mg/kg) | midazolam | 24 | 60 and 120 min after the procedure | Pediatric patients between 2 and 18 years of age who underwent esophagogastrodu odenoscopy (EGD) and/or colonoscopy for routine clinical indications | This study compared the safety and efficacy of fentanyl and meperidine for analgesia in pediatric gastrointestinal endoscopy | Meperidine and Fentanyl are equally effective in providing analgesia for pediatric gastrointestinal endoscopy. | |||
| DISMA 2005 | randomized, prospective, three-study-group | Italy | propofol alone (Group P) | propofol with fentanyl 1 μg kg 1 (Group PF) | propofol with midazolam 0.1mgkg 1 (Group PM) | Additional doses of propofol | 240 | Patient recovery was assessed at 5 min intervals | paediatric outpatients, ASA I–II, aged 1–12-yr old, scheduled for diagnostic endoscopic procedures of the upper gastrointestinal tract | investigate sedation in children using propofol alone or combined with fentanyl or midazolam with regard to efficacy, adverse reactions or side-effects related to the drugs, ease of operation for the endoscopist, and time to discharge from the post-anaesthesia care unit | Propofol in combination with fentanyl or midazolam gives better sedation and ease of endoscopy than propofol alone | ||
| PASPATIS 2006 | Prospective, Randomized Study | Greece | oral 0.5 mg/kg of midazolam (maximum dose 20 mg) and IV doses of propofol 0.5 mg/kg | IV doses of propofol 0.5 mg/kg | N/E | 54 | N/E | Children (aged 3 y or older) who underwent Upper Gastrointestinal Endoscopies (UGIE) | compare the required dose of intravenous (IV) propofol between group A (synergistic sedation with an oral dose of midazolam combined with IV propofol) and group B (IV propofol alone), in diagnostic upper gastrointestinal endoscopy (UGIE) in pediatric patients | Synergistic sedation with an oral dose of midazolam combined with propofol may benefit the children who undergo UGIE with regard to lower mean dose of propofol used, easier IV line placement, easier separation from the parents, less pain induced by the IV line placement and greater patient comfort | |||
N/E not evaluated