Combined oral midazolam–ketamine better than midazolam alone for sedation of young children: a randomized controlled trial

Moreira, Thiago Anderson; Costa, Paulo Sucasas; Costa, Luciane Rezende; Jesus-França, Cristiana Marinho; Antunes, Denise Espíndola; Gomes, Hugo Sérgio Oliveira; Neto, Onofre Alves

doi:10.1111/j.1365-263x.2012.01246.x

Cited by 30 publications

(30 citation statements)

References 20 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results of this study, despite the limitations in the statistical significance, show families in need of social skills but, on the other hand, a beneficial effect of conscious sedation to reduce the suffering of the preschool child in the dentist’s chair, as already shown [20]. Thus, parenting practices should also be addressed by a multidisciplinary health care team for the child in need of elective procedures under pharmacological intervention.…”

Section: Discussionsupporting

confidence: 55%

“…So, it was not possible to compare the two sedative regimes regarding their association with children’s behavior and parental educational social skills. Another investigation showed the superiority of midazolam/ketamine for children’s behavior management when compared with midazolam alone, although less cooperative behaviors could also be observed in children that received ketamine [20]. In fact, the body of evidence points out to the efficacy and safety of ketamine in pediatric procedural sedation [21].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mother-child interactions and young child behavior during procedural conscious sedation

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundAs many preschoolers are not able to cooperate with health-related invasive procedures, sedation can help with the child’s comfort and allow the intervention to be done. It is scarcely known how parents affect children’s behavior during dental treatment under conscious sedation. The aim of this exploratory study was to analyze the association between mother-child interactions in day-to-day family life and preschool children’s behavior during dental treatment under conscious sedation.MethodsThis cross-sectional study included 27 children aged 2–6 years and their mothers. The children’s behavior during dental treatment under conscious sedation was verified through the analysis of videos and using an observational scale. Social skills of mothers were verified through interviews using the Parental Educative Social Skills Interview Script (RE-HSE-P); the sum of the scores allowed the establishment of the categories “clinical” and “non-clinical”. We presented descriptive analyses and bivariate associations.ResultsChildren’s overall behavior during dental sedation was: very poor (n = 2), poor (n = 1), regular (n = 2), good (n = 9), very good (n = 9) and excellent (n = 4). Social skills varied: parental educational social skills (n = 24 clinical vs. n = 3 non-clinical); child social skills (n = 20 vs. n = 7), context variables (n = 15 vs. n = 12), negative educational practices (n = 12 vs. n = 15), child behavior problems (n = 7 vs. n = 20). There was no association between child behavior under sedation and social skills categories (P > 0.05).ConclusionsThe majority of interviewed mothers reported issues in parental educational social skills and child social skills, which did not affect the outcomes of the children’s behavior during the procedural conscious sedation.

show abstract

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Mother-child interactions and young child behavior during procedural conscious sedation

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Second, both groups in the present study received an association of midazolam and ketamine, which has been proved effective in moderate sedation in both pediatric and dental settings [22, 23]. Other trials associated sevoflurane/nitrous oxide with intravenous midazolam [10], or only compared sevoflurane/nitrous oxide with nitrous oxide [9, 12].…”

Section: Discussionmentioning

confidence: 99%

Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial

Gomes

Sado-Filho

et al. 2017

BMC Pediatr

Self Cite

View full text Add to dashboard Cite

BackgroundThere is little evidence concerning the effect of sevoflurane in outpatient procedural sedation, especially in children. We hypothesised that the addition of sevoflurane to a sedation regimen improves children’s behaviour with minimal adverse events.MethodsThis is a randomised, triple-blind clinical trial conducted on an outpatient basis. Participants were 27 healthy children aged 4 to 6 years, who previously refused dental treatment with non-pharmacologic methods. All participants received oral midazolam (0.5 mg/kg, maximum 20 mg) and oral ketamine (3 mg/kg, maximum 50 mg) and, in addition: Group MK – 100% oxygen; Group MKS – inhalational sevoflurane at a sedative dose (final expired concentration between 0.3 and 0.4%). Dental appointments were video recorded for assessment of the children’s sleep patterns, crying, movements, and overall behaviour during the procedure with the Houpt scale. Intra- and post-operative adverse events were systematically reported. Data were analysed by bivariate analyses in the IBM SPSS v. 19, at a significance level of 5%.ResultsMK (n = 13) and MKS (n = 14) did not differ regarding the Houpt scores (P > 0.05), but 53.8% of children in the MK group showed hysterical and continuous crying at the time of the local anaesthesia injection, compared to 7.1% of children in the MKS group (P = 0.01; phi = 0.5). There was a trend toward less crying and movement over time during the dental appointment in the MKS group (P = 0.48). Minor adverse events were observed in 10 MK children and 4 MKS children (P = 0.01).ConclusionsThe addition of sevoflurane to oral midazolam-ketamine improved the children’s crying behaviour during local anaesthetic administration, and did not increase the occurrence of adverse events.Trial registrationClinical Trials NCT02284204. Registered 5 October 2014.

show abstract

“…A recent study demonstrated that combined ketamine-midazolam provided better results then midazolam alone for sedation of young children [Moreira et al, 2013]. But, children patients younger then 10 years receiving intravenous ketamine along with midazolam display more pronounced adverse effects [Wathen et al, 2000].…”

Section: Evaluation Of the Effect Of Midazolam And Ketoconazole On Kementioning

confidence: 99%

In vitro ketamine CYP3A‐mediated metabolism study using mammalian liver S9 fractions, cDNA expressed enzymes and liquid chromatography tandem mass spectrometry

Santamaria

Pailleux

Beaudry

2014

Biomedical Chromatography

View full text Add to dashboard Cite

Ketamine is widely used in medicine in combination with several benzodiazepines including midazolam. The objectives of this study were to develop a novel HPLC-MS/SRM method capable of quantifying ketamine and norketamine using an isotopic dilution strategy in biological matrices and study the formation of norketamine, the principal metabolite of ketamine with and without the presence of midazolam, a well-known CYP3A substrate. The chromatographic separation was achieved using a Thermo Betasil Phenyl 100 x 2 mm column combined with an isocratic mobile phase composed of acetonitrile, methanol, water and formic acid (60:20:20:0.4) at a flow rate of 300 µL/min. The mass spectrometer was operating in selected reaction monitoring mode and the analytical range was set at 0.05-50 µM. The precision (%CV) and accuracy (%NOM) observed were ranging from 3.9-7.8 and 95.9.2-111.1% respectively. The initial rate of formation of norketamine was determined using various ketamine concentration and K m values of 18.4 µM, 13.8 µM and 30.8 µM for rat, dog and human liver S9 fractions were observed respectively. The metabolic stability of ketamine on liver S9 fractions was significantly higher in human (T 1/2 = 159.4 min) compared with rat (T 1/2 = 12.6 min) and dog (T 1/2 = 7.3 min) liver S9 fractions. Moreover significantly lower IC 50 and K i values observed in human compared with rat and dog liver S9 fractions. Experiments with cDNA expressed CYP3A enzymes showed the formation of norketamine is mediated by CYP3A but results suggest an important contribution from others isoenzymes, most likely CYP2C particularly in rat.3

show abstract

Combined oral midazolam–ketamine better than midazolam alone for sedation of young children: a randomized controlled trial

Cited by 30 publications

References 20 publications

Mother-child interactions and young child behavior during procedural conscious sedation

Mother-child interactions and young child behavior during procedural conscious sedation

Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial

In vitro ketamine CYP3A‐mediated metabolism study using mammalian liver S9 fractions, cDNA expressed enzymes and liquid chromatography tandem mass spectrometry

Contact Info

Product

Resources

About