Comparison of systemic effects and recovery profiles of different sedation protocols in pediatric patients undergoing gastroscopy

Introduction & Aim: Gastroscopy in children is performed under sedation, yet the optimal regimen is uncertain. We compared ketamine–dexmedetomidine (KD), ketamine–propofol (KP), midazolam–ketamine–dexmedetomidine (MKD) and midazolam–ketamine–propofol (MKP) with respect to peri-operative respiratory metrics, haemodynamic stability, procedure time, complications, extra-sedative need and recovery profile. Methods: In this prospective observational study, 100 ASA I–II patients aged 6–12 years undergoing elective gastroscopy were randomised to one of the four combinations. Ketamine was given as rescue when additional sedation was required. Demographics, procedure duration, SpO₂, heart rate, blood pressure, intra-procedural events, BIS and Ramsay scores, cumulative rescue ketamine, family/endoscopist satisfaction, recovery scores, recovery time and recovery-phase adverse events, including nausea-vomiting, were documented. Results: Baseline characteristics and procedure length were similar (p > 0.05). Supplemental oxygen was needed in four KP cases only. KP preserved the most stable haemodynamics, whereas the other regimens showed significant fluctuations (p < 0.05). Immediately after induction, KP produced a lower BIS and higher Ramsay score; subsequent values were comparable (p > 0.05). No nausea-vomiting was observed. Agitation arose in two KD patients but in none of the other groups (p < 0.05). KP yielded the shortest discharge time and the highest family and endoscopist satisfaction (p < 0.001). Conclusion: For paediatric gastroscopy, ketamine–propofol provides rapid, deep yet controllable sedation, haemodynamic stability, swift recovery and high satisfaction, outperforming KD, MKD and MKP. Alternative regimens may be preferable in children with elevated respiratory risk.