The Efficacy and Safety of Procedural Sedoanalgesia with Midazolam and Ketamine in Pediatric Hematology

Abstract

Objective:The aim of this study is to investigate the efficacy and safety of sedoanalgesia performed outside the operating room by pediatricians trained in advanced airway management and life support.Materials and Methods:Midazolam and ketamine were administered consecutively by intravenous route under cardiorespiratory monitoring for painful procedures of pediatric hematology.Results:A total of 115 patients had 237 sedoanalgesia sessions. Sedation time was 24.02±23.37 s and sedation success was 92.5% (Ramsay scores of ≥5). Patient satisfaction was high. The recovery time was 28.81±14.4 min. Although statistically significant (p<0.01) increases in systolic and diastolic blood pressure, heart rate, and respiratory rate were observed without clinical importance, they improved without any intervention. No severe adverse events were observed.Conclusion:Sedoanalgesia with intravenous midazolam and ketamine for pediatric hematology and oncology patients’ painful minor invasive procedures performed in an optimally equipped setting outside the operating room by pediatricians trained and certificated in advanced airway management and life support is effective and safe.

Safety and Efficacy of Procedural Sedation and Analgesia in Pediatric Oncology Patients

“…Children with cancer undergo many procedures during the treatment, which are often painful and cause significant anxiety in them. Procedural sedation provides safe and effective control of pain and anxiety, which leads to an adequate degree of memory loss and minimal awareness of the procedure [2]. There are guidelines proposed by the American Academy of Pediatrics (AAP) and Joint Commission International Accreditation (JCIA) regarding the management of pain and anxiety associated with these procedures in children [3][4].…”

Perbandingan Efektivitas dan Keamanan Kombinasi Ketamin/Midazolam Dibandingkan Ketamin Tunggal sebagai Sedasi pada Anak

“…2,4,5 Penambahan midazolam sebelum pemberian ketamin memberikan efek amnesia total dan mengurangi keluhan nyeri pasca-prosedur. Rerata waktu pulih pada kelompok tunggal 12 menit, sedangkan pada kelompok kombinasi bervariasi antara 15 menit hingga 28 menit.…”

“…1 Sedasi dengan pemberian kombinasi ketamin/ midazolam digunakan oleh beberapa Pusat HematologiOnkologi Anak dapat mengurangi trauma fisik dan psikologis pada prosedur invasif, baik untuk pasien, orangtua, maupun dokter dan dapat meningkatkan kesuksesan prosedur. 2 Berdasarkan hal tersebut maka diajukan pertanyaan klinis sebagai berikut, "Bagaimanakah manfaat dan keamanan sedasi kombinasi ketamin/ midazolam intravena dibandingkan sedasi ketamin tunggal pada pasien anak yang akan menjalani tindakan aspirasi sumsum tulang dan kemoterapi intratekal? "…”

General anesthesia, conscious sedation, or nothing: Decision‐making by children during painful procedures

“…The existing literature examines pharmacological versus nonpharmacological support and sedation versus no sedation, and describes different ways to prepare children for these procedures . However, none of these studies included asking children directly about their preferences for the type of medical support.…”

“…We understood that the fear of the procedure was not neutralized by GA for some patients and that GA itself was a source of additional anxiety and discomfort, potentially due to its symbolic association with death. [30][31][32][33][34] The existing literature examines pharmacological versus nonpharmacological support [35][36][37][38][39][40] and sedation versus no sedation, 30,[41][42][43][44][45][46][47][48][49][50] and describes different ways to prepare children for these procedures. 11,51,52 However, none of these studies included asking children directly about their preferences for the type of medical support.…”