A Comparison of Two Different Doses of Rectal Ketamine Added to 0.5 mg.kg^-1 Midazolam and 0.02 mg.kg^-1 Atropine in Infants and Young Children

Sep 28, 2010Anaesthesia and intensive care

Comparing two doses of rectal ketamine combined with midazolam and atropine in infants and young children

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Abstract

More patients in the high-dose group (MKK) were asleep during parental separation, with 62% compared to 35% in the low-dose group (MK).

The high-dose group (MKK) received 8 mg x kg(-1) ketamine, while the low-dose group (MK) received 4 mg x kg(-1) ketamine.
A significant increase in sedation scores was observed at both time points for the high-dose group.
Fewer patients in the high-dose group cried during intravenous cannulation (37%) compared to the low-dose group (68%).
Vital signs at the time of parental separation showed no significant differences between the two groups.
No adverse respiratory events were reported during the study.

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In some circumstances, a high degree of sedation that results in a child being unconscious at the time of parental separation is desirable. We set out to investigate the efficacy and safety of a rectal premedication regimen designed to produce this increased level of sedation. Sixty-seven children aged two to 24 months were randomised into two groups. Group MK received 4 mg x kg(-1) ketamine, 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine and group MKK received 8 mg x kg(-1) ketamine, 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine per rectum. The sedation score at the time of parental separation 30 minutes after drug administration and the response to intravenous cannulation were evaluated on a four-point scale. Respiratory rate, heart rate and arterial oxygen saturation were recorded immediately before parental separation. More patients in group MKK were asleep during separation (62 vs 35%, P < 0.05). Fewer patients in group MKK cried during intravenous cannulation (37 vs 68%, P < 0.05). Sedation scores were significantly increased at both time points. There was no difference between groups in vital signs at the time of parental separation and no adverse respiratory events occurred during the study period. In cases where a high degree of sedation following premedication in infants and toddlers is desired, the addition of 8 mg x kg(-1) ketamine to 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine administered rectally is more efficacious than 4 mg x kg(-1) ketamine.

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