EFFECTIVENESS AND SAFETY OF INTRAVENOUS KETAMINE AND INTRAVENOUS MIDAZOLAM USE AS SEDATION AGENTS FOR PROCEDURES INVOLVING PEDIATRIC AGE GROUP
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Keywords
Ketamine, midazolam, pediatric, safety, sedative.
Abstract
Background: In the emergency department, children are presented with pain and are at risk of developing significant anxiety due to fear of further pain. Effective sedation is essential for reducing child anxiety and pain, increasing parental satisfaction, and for successful surgical procedures.
Objective: To compare the safety and effectiveness of intravenous ketamine and midazolam as sedatives in children presented in the emergency department.
Methods: A quasi-experimental study was conducted at Ziauddin University Hospital Karachi. A total of 210 children aged 1–15 years who required surgical procedures were selected consecutively from the emergency department during the period of six months (January to June 2024). They were divided into groups of 105. 1 mg/kg of ketamine and 0.05 mg/kg of midazolam were administered intravenously in group A and B patients, respectively. Safety and effectiveness of both drugs were observed till discharge. Statistical package for social sciences (SPSS) version 24 was used for statistical interpretation of collected data.
Results: Of the total, 60.0% and 45.7% of children were male, while 40.0% and 54.3% were females in the midazolam and ketamine groups, respectively. The adverse effects were significantly higher (p-value <0.001) in midazolam group (40.0%) than ketamine group (5.7%). Similarly, median FLACC score was significantly higher (p-value <0.001) in the midazolam group (6.0) than ketamine group (3.0). 94.3% and 92.4% of children were discharged from the emergency department, whereas 5.7% and 3.8% were admitted in the midazolam and ketamine groups, respectively.
Conclusion: Intravenous ketamine safely and effectively manage the children in the emergency department as a sedative agent.
References
2. Trottier ED, Doré-Bergeron MJ, Chauvin-Kimoff L, Baerg K, Ali S. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatr Child Health. 2019 Dec 9;24(8):509-21.
3. Tervonen M, Kallio M, Peltoniemi O. National survey revealed variable practices in paediatric procedural sedation and patient monitoring. Acta Anaesthesiol Scand. 2021 Jul;65(6):747-54.
4. Dobson G, Chau A, Denomme J, Frost S, Fuda G, Mc Donnell C, et al. Guidelines to the practice of anesthesia—revised edition 2024. Can J Anaesth. 2024 Jan;71(1):8-54.
5. Chandra V, Kumar A, Sinha C, Kumar A. Nonoperating room regional anesthesia in pediatric patients: A review of indications and challenges. J Indra Gandhi Inst Med Sci. 2024 Jul 1;10(2):107-13.
6. Peng L, Morford KL, Levander XA. Benzodiazepines and related sedatives. Med Clin. 2022 Jan 1;106(1):113-29.
7. Aslaner MA, Baykan N. Use of controlled medications in the emergency department: narcotics and psychotropics. Eur J Ther. 2020;26(3):160-4.
8. Azevedo K, Johnson M, Wassermann M, Evans-Wall J. Drugs of abuse—opioids, sedatives, hypnotics. Crit Care Clin. 2021 Jul 1;37(3):501-16.
9. Gitlin J, Chamadia S, Locascio JJ, Ethridge BR, Pedemonte JC, Hahm EY, et al. Dissociative and analgesic properties of ketamine are independent. Anesthesiology. 2020 Nov 1;133(5):1021-8.
10. Dasari LN, Ninave S. A Narrative review of the efficacy and safety of oral ketamine in pediatric sedation: a critical analysis of current evidence. Cureus. 2024 Aug 22;16(8):e67550.
11. Flores-Pérez C, Moreno-Rocha LA, Chávez-Pacheco JL, Noguez-Méndez NA, Flores-Pérez J, Alcántara-Morales MF, et al. Sedation level with midazolam: a pediatric surgery approach. Saudi Pharm J. 2022 Jul 1;30(7):906-17.
12. Lingamchetty TN, Hosseini SA, Saadabadi A. Midazolam. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
13. Chun MK, Lee JY, Lee JS, Ryu JM, Choi SJ, Park JS. Safety and efficacy of pediatric sedation protocol for diagnostic examination in a pediatric emergency room: a retrospective study. Medicine. 2023 Jun 23;102(25):e34176.
14. Heydari F, Shabani H, Majidinejad S, Nasr-esfahani M. Efficacy and safety of intranasal midazolam versus chloral hydrate as sedation for quality computed tomography imaging in children. J Pediatr Res. 2019;6(4):286-91.
15. Janiani P, Gurunathan D. Comparison of efficacy and safety of midazolam versus nitrous oxide as sedative agents during paediatric dental treatment: a systematic review. Pesqui Bras Odontopediatria Clin Integr. 2024 Mar 22;24:e230043.
16. Sirimontakan T, Artprom N, Anantasit N. Efficacy and safety of pediatric procedural sedation outside the operating room. Anesth Pain Med. 2020 Aug;10(4):e106493.
17. Hedén L, von Essen L, Ljungman G. Children's self‐reports of fear and pain levels during needle procedures. Nurs Open. 2020 Jan;7(1):376-82.
18. Hanberger L, Tallqvist E, Richert A, Olinder AL, Forsner M, Mörelius E, et al. Needle-related pain, affective reactions, fear, and emotional coping in children and adolescents with type 1 diabetes: a cross-sectional study. Pain Manag Nurs. 2021 Aug 1;22(4):516-21.
19. Wang Y, Guo L, Xiong X. Effects of virtual reality-based distraction of pain, fear, and anxiety during needle-related procedures in children and adolescents. Front Psychol. 2022 Apr 19;13:842847.
20. Chan AY, Ge M, Harrop E, Johnson M, Oulton K, Skene SS, et al. Pain assessment tools in paediatric palliative care: a systematic review of psychometric properties and recommendations for clinical practice. Palliat Med. 2022 Jan;36(1):30-43.
21. Behkam S. Pain assessment scales in children: a comparative narrative review of existing tools. Int J Musculoskelet Pain Prevent. 2024 Mar 10;9(1):975-82.
22. Tabatabaei SM, Miri-Aliabad G, Boroojeny SB, Arab A. Sedative and analgesic effects of intravenous midazolam and ketamine combination in bone marrow aspiration and biopsy of childhood cancer. Zahedan Journal of Research in Medical Sciences. 2022 Jan 31;24(1):e118151.
23. Lang B, Wang H, Fu Y, Zeng L, Huang L, Zhang Q, et al. Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials. BMC Anesthesiol. 2022 Dec 22;22(1):399.
24. Simonini A, Brogi E, Cascella M, Vittori A. Advantages of ketamine in pediatric anesthesia. Open Med. 2022 Jul 6;17(1):1134-47.
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Dr Sana Ilyas
Postgraduate Resident MD Emergency Medicine, Dr. Ziauddin Hospital North, Karachi Pakistan. Email: sanailyas1693@gmail.com
Dr Inayat Ali Khan
Neurosurgeon, Assistant Professor, HOD Emergency Medicine, Dr. Ziauddin Medical University Hospital Karachi Pakistan. Email: Inayatbrain@yahoo.com
Dr Abdul Sami
Senior Registrar, Emergency Medicine, Dr. Ziauddin Medical University Hospital Karachi Pakistan. Email: doctorsb78@yahoo.com
Dr Muhammad Asad khan
Registrar, Emergency Medicine, Dr. Ziauddin Medical University Hospital Karachi Pakistan. Email: Dr.asad071@gmail.com
Dr Muhammad Uzair
Postgraduate MD Emergency Medicine, Ziauddin Hospital north Nazimabad Karachi Pakistan. Email: Uzair265@icloud.com
Dr Khalid Khan
Postgraduate MD Emergency Medicine, Dr. Ziauddin Hospital North Nazimabad, Karachi Pakistan. Email Khalidkhaan85@gmail.com
Dr Alvina Khan
Registrar, Emergency Medicine, Dr. Ziauddin Medical University Hospital Karachi Pakistan. Email: Khanalvina81@gmail.com