Ketamine and Midazolam for Invasive Procedures in Children with Malignancy: A Comparison of Routes of Intravenous, Oral, and Rectal Administration

Sep 11, 2004Journal of tropical pediatrics

Ketamine and midazolam for invasive procedures in children with cancer: comparing IV, oral, and rectal use

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Abstract

Optimal sedation was achieved in 78 percent of children undergoing invasive procedures with ketamine and midazolam.

Sedation effectiveness did not differ statistically among intravenous, oral, and rectal administration methods.
No severe complications were reported in any of the treatment groups.
Recovery time was notably longer for the intravenous group, exceeding 120 minutes in two patients.
Hallucinations occurred in 12 percent of patients receiving intravenous medication, which were not observed in those receiving oral or rectal forms.

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We investigated the efficacy of a combination of ketamine and midazolam, comparing intravenous, oral, and rectal administrations for invasive procedures in children with malignancy. Seventy-three children under 5 years of age, who were scheduled for invasive procedure, were assigned to one of three groups: IV group (n = 25), ketamine 1 mg/kg and midazolam 0.05-0.1 mg/kg were given intravenously; PO group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg were given orally; and PR group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg given rectally. Vital signs including blood pressure, pulse rate, respiratory rate, and oxygen saturation were monitored, and patients were observed for side-effects. Optimal sedation (drowsy and asleep) was provided in 78 per cent of all patients and no statistical difference was observed among the three groups. No severe complications were observed in all groups. Recovery time from sedation was significantly longer in the intravenous group (>120 min in two patients). Hallucination was noted in three (12 per cent) patients given intravenous medication, but not in those given oral or rectal medications. It is concluded that intravenous, oral, and rectal midazolam/ketamine are equally effective for invasive procedures in children with malignancy. The use of intravenous ketamine/midazolam may produce prolonged sedation and psychedelic effects in children. These adverse effects may alter the child's comfort and parental satisfaction.

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