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DOI: 10.4103/2231-0770.197507
Procedural moderate sedation with ketamine in pediatric critical care unit
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Abstract
Objective: To evaluate the safety and efficacy of moderate sedation in the Pediatric Intensive Care Unit (PICU) settings according to moderate sedation protocol using ketamine and midazolam and to determine areas for the improvement in our clinical practice. Settings and Design: A retrospective study was conducted in the PICU. Materials and Methods: Retrospective chart review was performed for patients who had received moderate sedation between January and the end of December 2011 and who are eligible to inclusion criteria. Results: In this study, 246 moderate sedation sessions were included. 5.3% were in infant age, while 94.7% were children (1-14 years). Their gender distributed as 59.8% males and 40.2% females. The majority of them had hematology-oncology disease nature, i.e., 80.89% (n = 199). Lumbar puncture accounted for 65.3% (n = 160) of the producers; the rests were bone marrow aspiration 32.7%, endoscopy 8.2%, and colonoscopy 2.9%. Two doses of ketamine (1-1.5 mg/kg) to achieve moderate sedation during the procedure were given to 44.1% (n = 108) of the patients. One dose of midazolam was given to 77.2% (n = 190), while 1.22% (n = 3) of sessions of moderate sedation was done without any dose of midazolam. Adverse events including apnea, laryngeal spasm, hypotension, and recovery agitation were observed during moderate sedation sessions, and it has been noticed in four sessions, i.e., 1.6%, which were mild to moderate and managed conservatively. Conclusion: Moderate sedation in the PICU using ketamine and midazolam is generally safe with minimal side effects as moderate sedation sessions were conducted by pediatric intensivist in highly monitored and equipped environment.
Publication History
Article published online:
09 August 2021
© 2017. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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References
- 1 American Academy of Pediatrics; American Academy of Pediatric Dentistry, Coté CJ, Wilson S; Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: An update. Pediatrics 2006;118:2587-602.
- 2 Borland M, Esson A, Babl F, Krieser D. Procedural sedation in children in the emergency department: A PREDICT study. Emerg Med Australas 2009;21:71-9.
- 3 Collins CE, Everett LL. Challenges in pediatric ambulatory anesthesia: Kids are different. Anesthesiol Clin 2010;28:315-28.
- 4 Doyle L, Colletti JE. Pediatric procedural sedation and analgesia. Pediatr Clin North Am 2006;53:279-92.
- 5 Krauss B, Green SM. Sedation and analgesia for procedures in children. N Engl J Med 2000;342:938-45.
- 6 Miqdady MI, Hayajneh WA, Abdelhadi R, Gilger MA. Ketamine and midazolam sedation for pediatric gastrointestinal endoscopy in the Arab world. World J Gastroenterol 2011;17:3630-5.
- 7 Mistry RB, Nahata MC. Ketamine for conscious sedation in pediatric emergency care. Pharmacotherapy 2005;25:1104-11.
- 8 Morton NS. Ketamine for procedural sedation and analgesia in pediatric emergency medicine: A UK perspective. Paediatr Anaesth 2008;18:25-9.
- 9 Ng KC, Ang SY. Sedation with ketamine for paediatric procedures in the emergency department - A review of 500 cases. Singapore Med J 2002;43:300-4.
- 10 Herd D, Anderson BJ. Ketamine disposition in children presenting for procedural sedation and analgesia in a children′s emergency department. Paediatr Anaesth 2007;17:622-9.
- 11 Hession PM, Joshi GP. Sedation: Not quite that simple. Anesthesiol Clin 2010;28:281-94.
- 12 Kye YC, Rhee JE, Kim K, Kim T, Jo YH, Jeong JH, et al. Clinical effects of adjunctive atropine during ketamine sedation in pediatric emergency patients. Am J Emerg Med 2012;30:1981-5.
- 13 Mace SE, Barata IA, Cravero JP, Dalsey WC, Godwin SA, Kennedy RM, et al. Clinical policy: Evidence-based approach to pharmacologic agents used in pediatric sedation and analgesia in the emergency department. Ann Emerg Med 2004;44:342-77.
- 14 Godoy ML, Pino AP, Córdova LG, Carrasco OJ, Castillo MA. Sedation and analgesia in children undergoing invasive procedures. Arch Argent Pediatr 2013;111:22-8.
- 15 Koh JL, Palermo T. Conscious sedation: Reality or myth? Pediatr Rev 2007;28:243-8.
- 16 Sherwin TS, Green SM, Khan A, Chapman DS, Dannenberg B. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial. Ann Emerg Med 2000;35:229-38.