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Titolo:
A comparison of intramuscular ketamine with high dose intramuscular midazolam with and without intranasal flumazenil in children before suturing
Autore:
McGlone, R; Fleet, T; Durham, S; Hollis, S;
Indirizzi:
Royal Lancaster Infirm, Dept Accid & Emergency, Lancaster LA1 3ES, EnglandRoyal Lancaster Infirm Lancaster England LA1 3ES caster LA1 3ES, England Univ Lancaster, Med Stat Unit, Lancaster LA1 4YW, England Univ Lancaster Lancaster England LA1 4YW nit, Lancaster LA1 4YW, England
Titolo Testata:
EMERGENCY MEDICINE JOURNAL
fascicolo: 1, volume: 18, anno: 2001,
pagine: 34 - 38
SICI:
1472-0205(200101)18:1<34:ACOIKW>2.0.ZU;2-J
Fonte:
ISI
Lingua:
ENG
Soggetto:
PEDIATRIC-PATIENTS; LACERATION REPAIR; ORAL MIDAZOLAM; SEDATION; PHARMACOKINETICS; PREMEDICATION;
Keywords:
suturing; children; midazolam; intranasal flumazenil; ketamine;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
23
Recensione:
Indirizzi per estratti:
Indirizzo: McGlone, R Royal Lancaster Infirm, Dept Accid & Emergency, Ashton Rd, Lancaster LA1 3ES, England Royal Lancaster Infirm Ashton Rd Lancaster England LA1 3ES and
Citazione:
R. McGlone et al., "A comparison of intramuscular ketamine with high dose intramuscular midazolam with and without intranasal flumazenil in children before suturing", EMERG MED J, 18(1), 2001, pp. 34-38

Abstract

Objectives-(a) To compare the use of high dose intramuscular midazolam with and without intranasal flumazenil in children after suturing. (b) To compare the use of high dose intramuscular midazolam with low dose intramuscular ketamine in children before suturing. Methods-87 children, aged between 1 and 7 years, presenting with simple wounds needing sedation, were studied. Children considered combative (n=47) were given ketamine (2.5 mg/kg intramuscularly). The remaining 40 children were given midazolam (0.4 mg/kg intramuscularly) with and without flumazenil(25 mug/kg, intranasally). Results-The median oxygen saturation was 97% in both midazolam groups. Flumazenil significantly reduced the amount of agitation during recovery (p=0.048) and also the time at which children were ready for discharge (median 55 versus 95 minutes, p value <0.001). After discharge both midazolam groupshad an unsteady gait (75%) and there was no significant difference in the duration. As expected because of the deliberate selection of combative children into the ketamine group, the pre-sedation behaviour was slightly more disturbed compared with the midazolam group (p=0.10). However, the ketaminegroup was less agitated during local anaesthetic and suturing p<0.001. Conclusion-Intramuscular midazolam (0.4 mg/kg) did not effectively sedate the children, in that a significant number still had to be restrained. However, none could remember the suturing. Intranasal flumazenil seems to be effective in shortening the time to discharge. If midazolam is to be used then a dose high enough to produce full amnesia should be used, there seems tobe no advantage in increasing the dose further. Low dose intramuscular ketamine remains the drug of choice.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/04/20 alle ore 13:27:00