Long term high dose morphine, ketamine and midazolam infusion in a child with burns.

Cederholm, Ingemar; Bengtsson, Mats; Björkman, Sven; Choonara, I A; Rane, Anders

doi:10.1111/j.1365-2125.1990.tb05459.x

Cited by 29 publications

(14 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…7 The goal of sedation in the ICU is a patient who is calm, possibly lightly asleep, but easily arousable. Sedation in children can be even more difficult to achieve because of parental separation, stranger fear, incomprehension, and degree of perceived situational con trol.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Dexmedetomidine and Midazolam for Sedation in Severe Pediatric Burn Injury

Fagin

Palmieri

Greenhalgh

et al. 2012

Journal of Burn Care & Research

View full text Add to dashboard Cite

Dexmedetomidine (DEX) is an α-adrenergic agonist that has been used for sedation during invasive procedures and endotracheal intubation. In pediatric burn injury, DEX has been shown to be safe as a long-term sedative in the intensive care unit (ICU). However, comparison of DEX with traditional sedatives, such as midazolam, for sedation in pediatric burn injury has not been performed. The purpose of this study was to compare DEX with midazolam in terms of sedation, efficacy, and side effects in children with burn injury. A retrospective review of all children with a TBSA burn injury ≥20% admitted from December 2008 to September 2010 was performed. Children who received a continuous DEX infusion were compared with children receiving a continuous midazolam infusion. Data collected included: age, TBSA burn, ventilator days, ICU days, hypotensive episodes, bradycardic episodes, and Richmond Agitation Score (RAS). A total of 21 patients who received DEX infusions were compared with 21 age-matched and burn size-matched patients who received midazolam infusions. Of the 21 DEX patients, nine also received midazolam infusions, eight prior to DEX and one after. These patients did not receive DEX and midazolam simultaneously. There was no difference in age (6.9 vs 6.4 years), TBSA (45.5 vs 49.2%), ICU days (45.3 vs 55.4), and ventilator days (38.5 vs 45.5) between the DEX and midazolam patients, respectively. The mean duration of infusion was 22.5 ± 24.9 days for DEX and 20.1 ± 24.8 days for midazolam. DEX patients had a mean RAS of -0.91 ± 0.8. Midazolam patients were more sedated with a mean RAS of -1.33 ± 0.7. Only one episode of bradycardia was noted in the DEX group. The DEX group had fewer hypotensive episodes (mean arterial pressure <60 mm Hg) while on infusion compared with the midazolam group (15.8 vs 29.7 episodes). Thus, it can be surmised that DEX is a safe and effective sedative for pediatric burn patients. Compared to midazolam, DEX may provide more effective sedation and less sedation-related hypotension.

show abstract

Section: Discussionmentioning

confidence: 99%

A Comparison of Dexmedetomidine and Midazolam for Sedation in Severe Pediatric Burn Injury

Fagin

Palmieri

Greenhalgh

et al. 2012

Journal of Burn Care & Research

View full text Add to dashboard Cite

show abstract

“…Bei Schmerzen trotz Gabe extrem hoher Opioiddosen sollte das Verhältnis von Morphin-3-Glukoronid und Mor-phin frühzeitig bestimmt werden, um eine morphinbedingte Allodynie als Ursache des steigenden Morphinbedarfs auszuschließen [4]. Der M-3-G/Morphin-Quotient ist altersabhängig und betrug bei einem 9 Monate alten Mädchen mit morphininduzierter Allodynie unter der Therapie mit bis zu 6950 µg/ kg/h Morphin maximal 42 [10].…”

Section: Hintergrundschmerzunclassified

Schmerztherapie bei akuten pädiatrischen Erkrankungen und Impfungen

2000

View full text Add to dashboard Cite

PHENOMENON PAIN: While pain is one of the main reasons for an unscheduled visit to the paediatrician, pain due to painful procedures is of major importance in scheduled visits. Actual pain therapy is illustrated in the treatment of burns. Incomplete analgesia may have an unfavourable impact on morbidity and mortality. The pain score does not correlate with the extent of the burned area, and is regularly underestimated. General anaesthesia or analgo-sedation are warranted during the care of the burned patient. INSUFFICIENT ANALGESIA: Consequence of insufficient analgesia during primary care is an increased need of analgesics, and an increased pain treatment failure rate during subsequent procedures. Pain is interfering with anxiety, sleep disturbances and post-traumatic psychologic alterations. All those symptoms must be treated adequately. ACUTE ILLNESS AND INJECTIONS: This article covers pain from otitis media, pharyngitis, Guillain-Barré syndrome, purpura fulminans, Toxic Epidermal Nekrolysis, as well as the usage of local anaesthesia during injections, not to forget the application of non-pharmacologic methods for pain therapy and prophylaxis.

show abstract

“…Bei Pa ti en ten mit mul tipler Me tas ta sie rung er rei chen die effek ti ven re gio nal an äs the sio lo gi schen Verfah ren we gen mul ti lo ka ler Schmer zen ihre Gren zen. Eine in tra ve nö se Schmerz thera pie mit tels elek tro nisch pro gram mier barer Pum pen über zen tral ve nö se Port sys teme kann für die se Pa ti en ten ein ef fek ti ves Ver fah ren dar stel len [28].Die ses Vor ge hen gilt bei ent spre chend schwe rer Grund er kran kung im Kin desalter ge nau so wie beim Er wach se nen [4,13,30]. Wir möch ten die sen Stand punkt mit der fol gen den Fall dar stel lung über die Schmerz the ra pie ei ner kind li chen Tumor er kran kung un ter mau ern/be le gen, die nach der Um stel lung von ei ner me dika men tö sen Po ly prag ma sie auf eine konti nu ier li che Mor phin-/(S)-Ket amin-Ap plika ti on ef fek tiv war.…”

unclassified

“…Die ses Vor ge hen gilt bei ent spre chend schwe rer Grund er kran kung im Kin desalter ge nau so wie beim Er wach se nen [4,13,30]. Wir möch ten die sen Stand punkt mit der fol gen den Fall dar stel lung über die Schmerz the ra pie ei ner kind li chen Tumor er kran kung un ter mau ern/be le gen, die nach der Um stel lung von ei ner me dika men tö sen Po ly prag ma sie auf eine konti nu ier li che Mor phin-/(S)-Ket amin-Ap plika ti on ef fek tiv war.…”

unclassified

Therapie extremer Tumorschmerzen mit Morphin und (S)-Ketamin

Laufer

Schippel

et al. 2005

Schmerz

View full text Add to dashboard Cite

We are reporting on the case of an 11-year old girl with a malignant tumour. The extreme pain throughout the body could not be treated by conventional methods. By intravenous application of a morphine and s-ketamine mixture we were able to achieve a very effective analgesic result. Apart from the opiate effect of the morphine the decisive factor was the NMDA-antagonism of the s-ketamine. The latter suppresses central sensitisation and chronic pain and reduces or even prevents the development of opioid tolerance. It was possible to use smaller opiate doses more effectively, thus reducing the side effects of the pain therapy. Under associated whole-body thermochemotherapy the girl experienced general pain relief and we were able to return to conventional therapy with a fentanyl plaster.

show abstract

Long term high dose morphine, ketamine and midazolam infusion in a child with burns.

Cited by 29 publications

References 25 publications

A Comparison of Dexmedetomidine and Midazolam for Sedation in Severe Pediatric Burn Injury

A Comparison of Dexmedetomidine and Midazolam for Sedation in Severe Pediatric Burn Injury

Schmerztherapie bei akuten pädiatrischen Erkrankungen und Impfungen

Therapie extremer Tumorschmerzen mit Morphin und (S)-Ketamin

Contact Info

Product

Resources

About