Use of intravenous ketamine‐midazolam association for pain procedures in children with cancer. A prospective study

Abstract

We evaluated the safety and efficacy of midazolam-ketamine association to control pain induced by diagnostic procedures in paediatric oncology patients. 226 procedures were carried out in 92 patients aged three days to 18 years. Drugs were given i.v. by an anaesthesiologist. Midazolam dose was 25 microg.kg-1 and ketamine 0. 5 to 2 mg.kg-1, depending on number and invasiveness of procedures. The mean dose of ketamine was 1 mg.kg-1. Mean duration of sedation was ten min. No complication was observed and analgesia was considered satisfactory in 89 out of 92 patients. These results indicate that midazolam-ketamine is a safe and effective association in pain management for paediatric oncology patients and efficiently induces brief unconscious sedation with analgesia.

Inter- and Intraindividual Variability in Ketamine Dosage in Repetitive Invasive Procedures in Children with Malignancies

“…Compared to data from the literature, the number of procedures with inadequate sedation in our study was comparable to the work from Pellier and co-workers (similar regimen with incremental dosages of ketamine) [7], but lower than the data reported by Marx et al (preset dosage regimen with 1.5 mg ketamine/kg body weight) [5]. The number of adverse side effects seen in our study cohort is equivalent to the results presented by Pellier et al and Parker et al (incremental dosage regimen) [6,7], but lower than in the study presented by Marx et al [5].…”

“…Many different sedative drugs have been employed for sedating children. Ketamine appears to be one of the most frequently used, possibly because of its analgesic effect providing concomitant stable respiratory and cardiovascular function [5][6][7][8]12]. Despite its widespread use, not much information is available concerning inter-and intrainividual variability in the required ketamine dosage to achieve adequate sedation in repetitive sedation procedures.…”

“…In 1990, the American Academy of Pediatrics published recommendations on the management of pain and anxiety related to procedures in children with cancer [1]. Subsequently, there have been increased efforts to manage the pain and stress of oncology-related procedures with psychological as well pharmacological interventions [2][3][4][5][6][7][8][9][10][11][12].…”

“…Ketamine sedation has become increasingly popular since it possesses strong analgesic effects without depressing respiratory and cardiovascular 162 S. Meyer et al function [5][6][7][8]12]. Only few data are available concerning inter-and intraindividual variability in ketamine dosage in repetitive invasive procedures.…”

Sedation and analgesia for brief diagnostic and therapeutic procedures in children

“…Ketamine/S-ketamine [7,12,16,17,19,29,37,38,46,48,55,58,59] Ketamine is one of the most frequently used analgesic agents in children, possibly because it provides concomitant stable respiratory and cardiovascular function. Ketamine acts as an antagonist at the N-methyl-D-aspartat (NMDA)-receptor, and stimulates via a re-uptake inhibition of catecholamine's up-regulation of the sympathetic efferent pathway, resulting in an increase of heart rate and blood pressure.…”