Midazolam-Ketamine (MK) Versus Propofol-Ketamine (PK) for Pediatric Burn Patients Undergoing Dressing Changes: A Non-Randomized Cross-Over Clinical Trial.

Ketamine is used as an anesthetic agent for pediatric burns patients due to its favorable pharmacological properties. However, concerns persist regarding its repeated administration in children due to potential neuropsychic adverse effects with varying reported prevalence in the literature. This study aimed to evaluate the similarity between midazolam and propofol in their ability to mitigate ketamine-associated neuropsychiatric effects. The non-randomized crossover clinical trial involved pediatric burn patients aged 4 months to 17 years who underwent dressing changes under general anesthesia. Each patient received the Midazolam-Ketamine and Propofol-Ketamine protocols, with a 48 to 72-hour interval. The study was carried out in the plastic, reconstructive, aesthetic and burn surgery unit. A total of 92 dressing changes were analyzed in 22 pediatric patients with a median age of 3 years. Of these patients, 45.5% had severe burns. The median doses of midazolam and propofol were 0.04 mg/kg and 1.47 mg/kg, respectively. Ketamine was administered at a median dose of 2.00 mg/kg for both protocols. Neuropsychic manifestations occurred in five cases with the Midazolam-Ketamine protocol, and two in the Propofol-Ketamine protocol without significant difference. Nystagmus was significantly more common in the Propofol-Ketamine protocol, while tachycardia, hypertensive spikes, and desaturation were more frequent in the Midazolam-Ketamine protocol. The Midazolam-Ketamine protocol was associated with a longer recovery time. In conclusion, both protocols could be considered similar in terms of preventing the presumed neuropsychic effects induced by ketamine. In light of this study, the Propofol-Ketamine protocol emerges as the preferred choice in our current practice due to its better hemodynamic and respiratory stability, as well as a faster wake-up time.