Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation

Abstract

The provision of adequate analgesia and anxiolysis is an important role for emergency physicians. Despite increased awareness of this subject in the medical literature, inadequate attention to pain and anxiety in paediatric patients continues. Recent reviews 1-5 have centred on safety issues in the delivery of sedative drugs in the non-operating room setting and highlight the need for controlled trials of diVerent sedative protocols used in children in varied settings. Ketamine and midazolam are two agents commonly used for sedating children during medical procedures but despite their reported suitability for procedural sedation in the emergency department (ED) setting 1 4 5 their use remains erratic. This study aimed to compare intranasal midazolam (INM) with a combination of intravenous ketamine plus intravenous midazolam (IVKM) for sedation of children requiring minor procedures, such as laceration repair or foreign body removal, in the ambulatory setting. A comparison of these methods in this particular setting has not previously been published. The ED in this study had existing protocols for these techniques and although INM was being used more frequently than IVKM, there were concerns regarding its reliability. We hypothesised that IVKM would more reliably produce a suitable level of sedation for minor procedures than INM and that both doctors and parents would be more satisfied with this method of sedation.

Umgang mit Schmerz und Stress an der Neonatologischen Intensivstation. Eine Evaluation in Österreich

“…Using anaesthetics may be time consuming and may exacerbate the clinical condition [21]. Furthermore, in many cases an umbilical-vessel line is the first approach, and until recently evidence of the efficacy and safety of intranasal benzodiazepines and other drugs had not been shown in neonates in this situation [22,23].…”

Use of midazolam and ketamine as sedation for children undergoing minor operative procedures

“…Although significant strides have been made in recognition of the risks of sedation and in development of guidelines for safe sedation practices [1,7,8], evidence-based data are lacking and further studies are required concerning the choice of different agents for different groups of patients under different circumstances. Because of its therapeutic index and low toxicity, chloral hydrate has long been a popular sedative-hypnotic drug for young children, but it is seldom successful to induce adequate sedation for painful procedures.…”

Pediatric Procedural Sedation with Ketamine: Time to Discharge after Intramuscular versus Intravenous Administration

“…Numerous studies and randomized controlled trials (RCTs) on the use of ketamine show a favorable safety profile, with a low risk of airway complications and emergence phenomena. [1][2][3][4][5][6][7][8][9][10] One of the key disadvantages of ketamine, however, is the long recovery period. The optimal parenteral mode of ketamine administration-intravenous (IV) versus intramuscular (IM)-has been discussed in only a small number of studies and reviews in terms of time to discharge and its relationship to the incidence of adverse events.…”