Comparison of low-dose ketamine to midazolam for sedation during pediatric urodynamic study

Introduction Aim of sedation during pediatric urodynamic studies (UDS) is a calm and cooperative child while not affecting measurements. We compared the effectiveness of midazolam to low-dose ketamine infusion for sedation and their impact on urodynamics. Materials and methods ASA-I children undergoing UDS were randomly assigned to group K (ketamine) loading dose (0.25mg center dot kg1) followed by infusion of 1020g center dot kg1 center dot min1 or group M (midazolam) loading dose of (0.02mg center dot kg1) followed by 12g center dot kg1 center dot min1. The sedation scores and reactivity to catheterization were monitored by Children Hospital of Wisconsin Sedation Scale and Frankl Behavior Rating Scale, respectively. The UDS included two-channel filling cystometry in supine position followed by a free uroflowmetry in sitting position. The UDS was performed and interpreted in accordance with good urodynamic practice guidelines of International Continence Society (2002). Results A total of 34 children were enrolled. Group K children (n=17) attained sedation earlier 6.80 (+/- 3.36) min vs. 9.40 (+/- 2.82) min; (P=0.03) than group M (n=17) and also recovered earlier 11.60 (+/- 3.13) min vs. 19.67 (+/- 5.49) min (P=0.01). Reactivity scores during urinary and rectal catheterization were lower in group K (P=0.03 and 0.01), respectively. Historical UDS data of 21 participants were available for comparison with effect of medication. None of the study drugs affected UDS parameters significantly. Conclusions Midazolam or low-dose ketamine provide satisfactory sedation during pediatric UDS without impacting urodynamic values.