the effect of preoperative combined with intravenous lidocaine and ketamine vs. intravenous ketamine on pediatric patients undergoing upper gastrointestinal endoscopy

Background: ketamine is widely used in pediatric sedation. new studies have recommended combination therapy to reduce the side effects of ketamine. objectives: this study investigated the effect of adding intravenous (iv) lidocaine to ketamine on hemodynamic parameters, endoscopist satisfaction, and recovery time of children undergoing gastrointestinal endoscopy. methods: this triple-blind, randomized, controlled clinical trial was conducted in isfahan, iran (2021). one hundred twenty children between the ages of 1 and 6 were enrolled. patients were divided into 2 groups. the intervention group received 1.0 mg/kg of iv lidocaine and 1.0 mg/kg of iv ketamine, and the placebo group received 1.0 mg/kg of iv ketamine and placebo 2 minutes before entering the endoscopic room. patients in both groups were sedated with 1.0 mg/kg of propofol, 0.1 mg/kg of midazolam, and 2.0 ug/kg of fentanyl for the procedure. the pulse rate, mean arterial pressure (map), respiratory rate, and oxygen saturation were recorded 1 minute before injection and every 5 minutes afterward. results: the mean (sd) ages of the intervention and control groups were 3.4 (1.5) and 3.4 (1.7), respectively. the mean difference in hemodynamic parameters between the 2 groups was insignificant during the investigation (p > 0.05). furthermore, no significant differences were found regarding endoscopist satisfaction scores and length of recovery room stay (p > 0.05). conclusions: adding low-dose iv lidocaine to ketamine for pediatric sedation does not significantly affect the hemodynamic status, endoscopist satisfaction, and recovery time.