Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children
(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.
... (More) - 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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1144067
- author
- Novak, Helene ; Karlsland Åkeson, Pia LU and Åkeson, Jonas LU
- organization
- publishing date
- 2008
- 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
- pmid:18095966
- 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
- 2016-04-01 13:53:02
- date last changed
- 2022-01-27 21:38:14
@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}},
keywords = {{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}},
doi = {{10.1111/j.1460-9592.2007.02388.x}},
volume = {{18}},
year = {{2008}},
}