الفهرس 
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Abstract
Endoscopic procedures are frequently required for the diagnosis and treatment of gastrointestinal diseases in children. Since such procedures can cause considerable anxiety and distress, many children find the procedures worse than disease itself.
The goal of sedation is to provide a patient who is only lightly sedated, cooperative on demand, free from anxiety and amnesic after the procedure. It must have a rapid onset, short duration of action, and should be safely administered by a non-anesthesiologist without significantly increased risk of potential complications. Unfortunately, there is no ideal sedation protocol for gastrointestinal endoscopy that is agreed upon by pediatric gastroenterologists. It appears that there is a wide variety of sedation techniques used by practicing pediatric gastroenterologists.
Ketamine is a unique dissociative drug introduced into clinical practice in 1970. It has anxiolytic, analgesic, amnesic and dissociative properties with a wide safety margin. It is most commonly used to facilitate short painful procedures.
Although ketamine-based sedation provides many of the desired effects of an ideal sedative, it is not widely used in pediatric gastrointestinal endoscopy. There is limited published research regarding its efficacy and safety, particularly in developing countries.
The aim of this study is to assess the safety of ketamine sedation for GI endoscopy in children.
This prospective study of pediatric patients with gastrointestinal symptoms who were indicated for upper or lower gastrointestinal endoscopy in Pediatric Endoscopy Unit, Abo El-Reesh Pediatric hospital, Cairo University. All children were > 2 year old and weighed > 6 kg.
A total of 100 pediatric patients including 53 males and 47 females with thier age ranged from 2 to 12 years with mean of 5.04 years, while their weight ranged from 6 to 36 kg with mean of 16.92 kg. All children were medicated with ketamine with a dose ranged from 2 to 5 mg/kg with mean of 3.77mg/kg. Ketamine injected intramuscularly (IM) in (65%) of cases and intravenously (IV) in (35%) of cases.
Analysis was performed in terms of sedation-related complications include desaturation, respiratory distress, apnea, bradycardia, cardiac arrest, emergence reactions.
Our results showed no complications occurred in 87% of cases. Desaturation occurred in 13% of the cases and was more frequent in Upper GI Endoscopy (14.28%) and with the intramuscular route (15.38%) and this was significant (p value= 0.049), however when it occurred, was reversed by supplemental oxygen. None developed apnea, bradycardia, arrest, or emergence reactions.
In conclusion, ketamine sedation appears safe for pediatric upper and lower gastrointestinal endoscopy in Egypt for children aged > 2 year and weighing > 6 kg without co-morbidities. Transient desaturation (13%) may occur but easily reversed by nasal oxygen administration.