Oral Ketamine/Midazolam Is Superior to Intramuscular Meperidine, Promethazine, and Chlorpromazine for Pediatric Cardiac Catheterization

Jan 29, 2000Anesthesia and analgesia

Oral ketamine and midazolam work better than injected meperidine, promethazine, and chlorpromazine for children’s heart catheter tests

AI simplified

PubMed ↗DOI ↗

Abstract

Oral ketamine/midazolam provided superior sedation and amnesia compared to IM meperidine, promethazine, and chlorpromazine (DPT) in a study of 51 children.

Ketamine/midazolam was better tolerated than IM DPT (P < 0.0005).
Onset of sedation was significantly faster with ketamine/midazolam (P < 0.001).
Efficacy of sedation was superior with the oral combination (P < 0.005).
Supplemental IV propofol was used more frequently and in larger doses after IM DPT (P < or = 0.02; P < 0.05).
Parental satisfaction ratings were higher for ketamine/midazolam (P < 0.005), and amnesia was more reliably achieved (P = 0.007).
Two patients needed airway support after receiving ketamine/midazolam, highlighting potential safety concerns.

AI simplified

UNLABELLED: An IM combination of meperidine, promethazine, and chlorpromazine (DPT) has been given as sedation for pediatric procedures for more than 40 years. We compared this IM combination to oral (PO) ketamine/midazolam in children having cardiac catheterization. A total of 51 children, ages 9 mo to 10 yr, were enrolled and randomized in this double-blinded study. All children received an IM injection at time zero and PO fluid 15 minutes later. We observed acceptance of medication, onset of sedation and sleep, and sedative efficacy. The cardiorespiratory changes were evaluated. Sedation was supplemented with IV propofol as required. Recovery time, parental satisfaction, and patient amnesia were assessed. Ketamine/midazolam given PO was better tolerated (P < 0.0005), had more rapid onset (P < 0.001), and provided superior sedation (P < 0.005). Respiratory rate decreased after IM DPT only. Heart rate and shortening fraction were stable. Oxygen saturation and mean blood pressure decreased minimally in both groups. Supplemental propofol was more frequently required (P < or = 0.02) and in larger doses (P < 0.05) after IM DPT. Parental satisfaction ratings were higher (P < 0.005) and amnesia was more reliably obtained (P = 0.007) with PO ketamine/midazolam. Two patients needed airway support after the PO medication, as did two other patients when PO ketamine/midazolam was supplemented with IV propofol. Although PO ketamine/midazolam provided superior sedation and amnesia compared to IM DPT, this regimen may require the supervision of an anesthesiologist for safe use.

IMPLICATIONS: Oral medication can be superior to IM injections for sedating children with congenital heart disease; however, the safety of all medications remains an issue.

Full Text

Full text is available at the source.

View full text ↗

Abstract

Full Text

Related papers

what lands in your inbox each week: