Ketamine versus opioids and midazolam for conscious sedation in children in the emergency department.Conscious sedation conscious sedation, n a state of sedation in which the patient remains aware of his or her person, surroundings, and conditions but without experiencing pain or anxiety. is a useful technique to reduce the pain and anxiety for children undergoing painful procedures. Which agent or combination of agents for use in children is the safest in the ED is still controversial. Prospective evaluation was of two different conscious sedation drug regimens, ketamine ketamine /keta·mine/ (ke´tah-men) a rapid-acting general anesthetic, used as the hydrochloride salt. ke·ta·mine n. and opioid/midazolam: 138 total conscious sedation procedures. Most common indications for conscious sedation: fracture reduction 91 (65.9%), laceration repair Laceration Repair Definition A laceration is a wound caused by a sharp object producing edges that may be jagged, dirty, or bleeding. Lacerations most often affect the skin, but any tissue may be lacerated, including subcutaneous fat, tendon, muscle, or 25 (18.1%), dislocation reduction 6 (4.3%), and dental procedures 5 (3.6%). Ketamine was used in 67 (48.5%), average dose 1.2 [+ or -] 0.4 mg/kg, range 0.8-3.1 mg/kg. Mean age was 6.6 [+ or -] 3.9 years, which was lower than opioids/midazolam (P < 0.5). Midazolam was given in 21 (31.3%). There were 5 (7.4%) patients who required oxygen. Average sedation Sedation Definition Sedation is the act of calming by administration of a sedative. A sedative is a medication that commonly induces the nervous system to calm. Purpose The process of sedation has two primary intentions. score was 2.8 [+ or -] 1.0, which was lower than opioids/midazolam group (P < 0.05). Mean recovery time was 24.0 [+ or -] 14.4 min (95 % CI, 20.5, 27.5), range of 3 to 75 minutes. Fentanyl fentanyl /fen·ta·nyl/ (fen´tah-nil) an opioid analgesic; the citrate salt is used as an adjunct to anesthesia, in the induction and maintenance of anesthesia, in combination with droperidol (or similar agent) as a neuroleptanalgesic, and or morphine morphine, principal derivative of opium, which is the juice in the unripe seed pods of the opium poppy, Papaver somniferum. It was first isolated from opium in 1803 by the German pharmacist F. W. A. plus midazolam were used in 51 (36.9%). Fentanyl was used in 12 (23.5%) with an average dose 1.3 [+ or -] 0.5 [micro]g/kg, range 0.4-3.2 [micro]g/kg. Morphine was used in 39 (76.4%) with an average dose 0.13 [+ or -] 0.06 mg/kg), range 0.02-0.3 [micro]g/kg. Midazolam was used with an average dose 0.08 [+ or -] 0.04 mg/kg, range 0.02-0.23 mg/kg. Mean age group was 11.0 [+ or -] 5.1 years. There were 2 (3.9%) patients who required oxygen administration. Average sedation score was 3.5 [+ or -] 0.9 Mean recovery time was 22.0 [+ or -] 12.3 min, range of 5 to 54 minutes. Conscious sedation in children in the ED using these techniques is safe; however, Ketamine was used more often in young children than opioid/midazolam and resulted in a deeper sedation score. Antonio E. Muniz, MD, Sam Bartle, MD, Chris Woleben, MD, Robin L. Foster, MD, and Steve Liner, MD. Department of Emergency Medicine and Pediatrics, Virginia Commonwealth University Formed by a merger between the Richmond Professional Institute and the Medical College of Virginia in 1968, VCU has a medical school that is home to the nation's oldest organ transplant program. Medical Center, Richmond, VA. |
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