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Titolo:
EFFICACY AND SAFETY OF INTRAVENOUS MIDAZOLAM AND KETAMINE AS SEDATIONFOR THERAPEUTIC AND DIAGNOSTIC PROCEDURES IN CHILDREN
Autore:
PARKER RI; MAHAN RA; GIUGLIANO D; PARKER MM;
Indirizzi:
SUNY STONY BROOK,DEPT PEDIAT,HSC T-11,ROOM 060 STONY BROOK NY 11794
Titolo Testata:
Pediatrics
fascicolo: 3, volume: 99, anno: 1997,
pagine: 427 - 431
SICI:
0031-4005(1997)99:3<427:EASOIM>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
CRITICALLY ILL PATIENTS; INTRAMUSCULAR MEPERIDINE; CONSCIOUS SEDATION; PEDIATRIC EMERGENCY; PLUS KETAMINE; PREMEDICATION; CHLORPROMAZINE; PROMETHAZINE; INTRANASAL; ANESTHESIA;
Keywords:
MIDAZOLAM; KETAMINE; SEDATION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
38
Recensione:
Indirizzi per estratti:
Citazione:
R.I. Parker et al., "EFFICACY AND SAFETY OF INTRAVENOUS MIDAZOLAM AND KETAMINE AS SEDATIONFOR THERAPEUTIC AND DIAGNOSTIC PROCEDURES IN CHILDREN", Pediatrics, 99(3), 1997, pp. 427-431

Abstract

Objective. We have used the combination of midazolam, a short-acting benzodiazepine, and ketamine, a ''dissociative anesthetic,'' to provide conscious sedation for invasive or lengthy procedures. Methods. A total of 350 procedures (74 lumbar punctures, 97 bone marrow aspirationsor biopsies, 84 radiotherapy sessions, and 95 imaging studies) were performed on 68 children, 4 months to 17 years of age, in both inpatient and ambulatory settings. All patients had an intravenous line in place and were monitored for heart rate and O-2 saturation by pulse oximetry for the duration of the procedure and recovery time. Blood pressure was monitored periodically (every 5 to 30 minutes). Oxygen and suction equipment was available during the procedure. In addition to the individual performing the procedure, a second staff member trained in airway management leg, physician, nurse practitioner, or registered nurse) was present to monitor vital signs and respiratory status. Patientswere sedated initially with midazolam (0.05 to 0.1 mg/kg intravenously; maximum single dose of 2 mg, maximum total dose of 4 mg), followed by ketamine (1 to 2 mg/kg intravenously). During lengthy procedures, additional doses of ketamine (0.5 to 1 mg/kg) were given as necessary. Effectiveness of the sedation, recovery time, and adverse events associated with the sedative regimen were documented. Results. All patientswere effectively sedated with this regimen. Four patients experiencedtransient decrease in O-2 saturation (<85%) requiring temporary interruption of the procedure and oxygen by blow-by; the procedure was subsequently completed without incident in each case. Two patients experienced significant agitation during recovery from sedation. This side effect resolved spontaneously after 5 to 10 minutes in one patient and was effectively treated with diphenhydramine hydrochloride in the other. Twenty-four lumbar punctures were associated with transient decreasein O, saturation (88% to 92%), which improved by relief of neck flexion and/or blow-by oxygen. No hypotension, bradycardia, or respiratory depression requiring respiratory support or reversal of sedation was noted. Anesthesia recovery time ranged from <15 minutes to 120 minutes with >70% of patients recovering within 30 minutes. Most patients demonstrated an increase in oral secretions requiring occasional suctioning. Transient sleep disturbances were reported in only two patients. Conclusions. This sedative regimen of intravenous midazolam and ketaminewas found to be safe and effective. Its use has greatly reduced patient and parent anxiety for diagnostic and therapeutic procedures.

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Documento generato il 14/08/20 alle ore 16:40:20