Safety of Ketamine-Midazolam[KM} and Fentany-Midazolam[FM] sedation for pediatric procedures on out patients basis
Sachdeva, A.; Gupta, S.P.; Yadav, S.P.; Gupta, D.; Soni, A. and Palta, C. (2002) Safety of Ketamine-Midazolam[KM} and Fentany-Midazolam[FM] sedation for pediatric procedures on out patients basis. In: SIOP XXXIV Meeting Medical & Pediatric Oncology, 2002, New Delhi, India.
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Introduction: KM & FM are used for sedation & analgesia in children for procedures. It produces potent analgesia, sedation & amnesia. Fentanyl (narcotic analgesic) has a short duration of action. A prospective study to analyze safety procedures on an and outpatient basis & evaluation of the relief of anxiety and pain. Method: Ketamine for sedation with premedication of midazolam and atropine was given by protocol. The children were fasting for 3 hrs. Complications and therapeutic interventions were monitored. For the FM group the pain during procedure was assessed with a 10 point Modified Children's Hospital of Eastern Ontario Pain Scale. Results: KM was used in 32 children. 30 were between 1-10 year, one < 1 year & 1 > 10 year. 31 were male. The procedures were BM (28), LP (8). The dose of Ketamine was 1 mg/kg (R = 0.5 mg/kg-5 mg/kg). The complications were airway malalignment (3 cases), transient apnea (1 case). There were no sequelae. Emesis was reported in 1 patient. 1 child was agitated on recovery. None needed hospitalization. FM had 24 children, average age 5 yr (3 months-15 years) & 16 males. The no. of procedures were 24, BM (16) & LP (8). Fentanyl dose used was 2 ugm/kg (Range 1-3 ugm/kg), and mida zolam 0.1 mg/kg. 2 children had hypoxia, which responded to oxygen therapy. The average pain score during procedure was 4 (Range 0-6). Conclusion: Ketamine can be administered safely, is effective, preserves protective airway reflexes & has a wide margin of safety. One should be careful about the position of airway. FM can be safely administered for procedures with appropriate monitoring. It is very effective, has a good safety profile & also very cost effective in our hands as the need for admission was obviated.
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