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Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children

Novak, Helene; Karlsland Åkeson, Pia LU and Åkeson, Jonas LU (2008) In Paediatric Anaesthesia 18(1). p.48-54
Abstract
Background: Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire-guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low-dose midazolam in young children undergoing these procedures before and also after discharge from the hospital.



Methods: A total of 244 biopsy procedures in 217 children under the age of 16 years were evaluated. All anesthesia records were reviewed according to a defined study protocol and in 145 cases the parents were also interviewed by telephone to obtain further information on possible adverse effects before and after discharge.

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Background: Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire-guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low-dose midazolam in young children undergoing these procedures before and also after discharge from the hospital.



Methods: A total of 244 biopsy procedures in 217 children under the age of 16 years were evaluated. All anesthesia records were reviewed according to a defined study protocol and in 145 cases the parents were also interviewed by telephone to obtain further information on possible adverse effects before and after discharge.



Results: Ketamine and low-dose midazolam were carefully titrated by an experienced anesthesia team at an approximate dose ratio of 40 : 1 (total doses 2.3 and 0.05 mg·kg−1) in continuously monitored spontaneously breathing children. Possibly associated problems before discharge were salivation (5.7%), vomiting (4.9%), oxygen desaturation (3.3%), laryngospasm (2.5%) and rash (1.2%) according to the patient records and blurred vision (27%), nausea and vomiting (19%), vertigo (13%) and hallucinations or nightmares (3.5%) according to telephone interviews. Few, mild and transient problems remained after discharge from the hospital.



Conclusions: Careful titration of ketamine and low-dose midazolam provides adequate sedation for nonsurgical pediatric short-term procedures also requiring considerable pharyngeal manipulation, particularly considering the low number of serious airway problems such as laryngospasm. The high incidence of late postoperative problems suggests that prospective studies should be designed for long-term follow-up of young children subjected to sedation or anesthesia. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
sedation, midazolam, ketamine, intestinal biopsy, children, Anesthesia, intravenous
in
Paediatric Anaesthesia
volume
18
issue
1
pages
48 - 54
publisher
Wiley-Blackwell
external identifiers
  • pmid:18095966
  • scopus:37249055064
ISSN
1460-9592
DOI
10.1111/j.1460-9592.2007.02388.x
language
English
LU publication?
yes
id
98b0be79-ac53-4819-ba7f-672d89725aa6 (old id 1144067)
date added to LUP
2008-08-12 12:29:34
date last changed
2017-01-01 05:55:55
@article{98b0be79-ac53-4819-ba7f-672d89725aa6,
  abstract     = {Background: Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire-guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low-dose midazolam in young children undergoing these procedures before and also after discharge from the hospital.<br/><br>
<br/><br>
Methods: A total of 244 biopsy procedures in 217 children under the age of 16 years were evaluated. All anesthesia records were reviewed according to a defined study protocol and in 145 cases the parents were also interviewed by telephone to obtain further information on possible adverse effects before and after discharge.<br/><br>
<br/><br>
Results: Ketamine and low-dose midazolam were carefully titrated by an experienced anesthesia team at an approximate dose ratio of 40 : 1 (total doses 2.3 and 0.05 mg·kg−1) in continuously monitored spontaneously breathing children. Possibly associated problems before discharge were salivation (5.7%), vomiting (4.9%), oxygen desaturation (3.3%), laryngospasm (2.5%) and rash (1.2%) according to the patient records and blurred vision (27%), nausea and vomiting (19%), vertigo (13%) and hallucinations or nightmares (3.5%) according to telephone interviews. Few, mild and transient problems remained after discharge from the hospital.<br/><br>
<br/><br>
Conclusions: Careful titration of ketamine and low-dose midazolam provides adequate sedation for nonsurgical pediatric short-term procedures also requiring considerable pharyngeal manipulation, particularly considering the low number of serious airway problems such as laryngospasm. The high incidence of late postoperative problems suggests that prospective studies should be designed for long-term follow-up of young children subjected to sedation or anesthesia.},
  author       = {Novak, Helene and Karlsland Åkeson, Pia and Åkeson, Jonas},
  issn         = {1460-9592},
  keyword      = {sedation,midazolam,ketamine,intestinal biopsy,children,Anesthesia,intravenous},
  language     = {eng},
  number       = {1},
  pages        = {48--54},
  publisher    = {Wiley-Blackwell},
  series       = {Paediatric Anaesthesia},
  title        = {Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children},
  url          = {http://dx.doi.org/10.1111/j.1460-9592.2007.02388.x},
  volume       = {18},
  year         = {2008},
}