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Titolo:
Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation
Autore:
Acworth, JP; Purdie, D; Clark, RC;
Indirizzi:
Royal Childrens Hosp, Dept Emergency Med, Brisbane, Qld 4029, Australia Royal Childrens Hosp Brisbane Qld Australia 4029 ane, Qld 4029, Australia Queensland Inst Med Res, Epidemiol & Populat Hlth Unit, Brisbane, Qld 4006, Australia Queensland Inst Med Res Brisbane Qld Australia 4006 , Qld 4006, Australia
Titolo Testata:
EMERGENCY MEDICINE JOURNAL
fascicolo: 1, volume: 18, anno: 2001,
pagine: 39 - 45
SICI:
1472-0205(200101)18:1<39:IKPMIS>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
INTRAMUSCULAR KETAMINE; PEDIATRIC PROCEDURES; PRESCHOOL-CHILDREN; LACERATION REPAIR; PREMEDICATION; ANALGESIA; EFFICACY; PATIENT; SAFETY; NASAL;
Keywords:
intranasal midazolam; intravenous ketamine; sedation; children;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
23
Recensione:
Indirizzi per estratti:
Indirizzo: Acworth, JP Royal Childrens Hosp, Dept Emergency Med, Herston Rd, Brisbane, Qld 4029, Australia Royal Childrens Hosp Herston Rd Brisbane Qld Australia 4029 ia
Citazione:
J.P. Acworth et al., "Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation", EMERG MED J, 18(1), 2001, pp. 39-45

Abstract

Objectives-This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation ofchildren requiring minor procedures in the emergency department. Method-A single blinded randomised clinical trial was conducted in the emergency department of a major urban paediatric hospital. Subjects requiring sedation for minor procedures were randomised to receive either INM (0.4 mg/kg) or intravenous ketamine (1 mg/kg) plus intravenous midazolam (0.1 mg/kg). Physiological variables and two independent measures of sedation (Sedation Score and Visual Analogue Sedation Scale) were recorded before sedationand at regular intervals during the procedure and recovery period. Times to adequate level of sedation and to discharge were compared. Results-Fifty three patients were enrolled over a 10 month period. Sedation was sufficient to complete the procedures in all children receiving IVKM and in 24 of the 26 receiving INM. Onset of sedation was an average of 5.3 minutes quicker with IVKM than with INM (95%CI3.2, 7.4 minutes, p<0.001). Children given INM were discharged an average of 19 minutes earlier than those given IVKM (95%CI 4, 33 minutes, p=0.02). Mean Sedation Scores and Visual Analogue Sedation Scale scores for the 30 minutes after drug administration were significantly better in children given IVKM compared with INM (2.4 and 1.8 versus 3.5 and 3.8, respectively). Both doctors and parents were more satisfied with sedation by intravenous ketamine and midazolam. Conclusions-Intravenous ketamine plus midazolam used in an appropriate setting by experienced personnel provides an excellent means of achieving sedation suitable for most non-painful minor procedures for children in the emergency department. This combination is superior to TNM in terms of speed ofonset and consistency of effect. INM delivered via aerosol spray has a more variable effect but may still be adequate for the completion of many of these procedures.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 18/02/20 alle ore 04:42:39