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Flores-González JC, Estalella-Mendoza A, Rodríguez-Campoy P, Saldaña-Valderas M, Lechuga-Sancho AM. Topical Pharyngeal Lidocaine Reduces Respiratory Adverse Events During Upper Gastrointestinal Endoscopies Under Ketamine Sedation in Children. Paediatr Drugs 2019; 21:25-31. [PMID: 30478762 DOI: 10.1007/s40272-018-0320-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Upper gastrointestinal endoscopies (UGEs) performed under ketamine sedation may increase the risk of respiratory adverse events (RAEs) due to pharyngeal stimulation. Topical lidocaine prevents general anesthesia-induced laryngospasm. OBJECTIVE Our objective was to determine whether topical lidocaine may reduce the incidence of RAEs induced by pharyngeal stimulation in UGEs performed on children sedated with ketamine. METHODS We conducted a single-center prospective study. We included every patient admitted for an elective diagnostic UGE under ketamine sedation who received lidocaine prior to the technique. Patients requiring any other medication were excluded. Our main outcome measure was the number of desaturation episodes. We then compared these results with those obtained in an historic group who did not receive topical lidocaine, in which we registered a total of 54 desaturation episodes. RESULTS In total, 88 children (52.3% boys) were included. The median age was 7 years [interquartile range (IQR) 3-11]. The mean duration of the procedure was 6.5 ± 2.4 min, and the median initial ketamine dose was 1.76 mg/kg (IQR 1.56-2.03). The total number of desaturation episodes was 3 (3.4%), and two of these occurred prior to the introduction of the endoscope. This result represents a lower incidence than in previously reported series, and a significant decrease (p < 0.0001) with respect to the 54 RAEs registered in the historic group of 87 children. CONCLUSIONS Topical lidocaine premedication significantly reduced the incidence of RAEs in children during UGEs under ketamine sedation. Our findings should be confirmed by a double-blind randomized controlled trial.
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Affiliation(s)
- Jose Carlos Flores-González
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Avda Ana de Viya 21, 11009, Cádiz, Spain. .,Institute of Research and Innovation in Biomedical Sciences (INIBiCA), Cadiz, Spain.
| | - Ana Estalella-Mendoza
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Avda Ana de Viya 21, 11009, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences (INIBiCA), Cadiz, Spain
| | - Patricia Rodríguez-Campoy
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Avda Ana de Viya 21, 11009, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences (INIBiCA), Cadiz, Spain
| | - Mónica Saldaña-Valderas
- Clinical Farmacology Unit, Puerta del Mar University Hospital, Cadiz, Spain.,Institute of Research and Innovation in Biomedical Sciences (INIBiCA), Cadiz, Spain
| | - Alfonso M Lechuga-Sancho
- Mother and Child Health, and Radiology Department, Cádiz University, Cadiz, Spain.,Institute of Research and Innovation in Biomedical Sciences (INIBiCA), Cadiz, Spain
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Rayala S, Kyander M, Haridass V, Palat G, Ström A, Wiebe T, Brun E, Segerlantz M. Low-dose Oral Ketamine as a Procedural Analgesia in Pediatric Cancer Patients Undergoing Bone Marrow Aspirations at a Resource-limited Cancer Hospital in India. Indian J Palliat Care 2019; 25:501-507. [PMID: 31673202 PMCID: PMC6812415 DOI: 10.4103/ijpc.ijpc_110_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: Many pediatric cancer patients undergo repeated bone marrow aspirations (BMAs) for diagnostic and treatment evaluation purposes. Full anesthesia is the standard of care during this procedure in high-income countries. At hospitals with low resources in low/middle-income countries many children undergo these painful procedures without sufficient pain relief. This study aimed to evaluate the usefulness of low-dose oral ketamine as a procedural analgesic in a low-resource pediatric cancer care department. Materials and Methods: Pediatric patients, 4–15 years of age, who underwent BMAs between September 31 and November 30, 2018, were invited to participate. The study was designed as a placebo-controlled, single-blinded trial with three trial groups. Group K received 1.0 mg/kg of ketamine and Group KM received 1.0 mg/kg ketamine with an addition of 0.2 mg/kg midazolam, mixed in juice 30 min before procedures. Group P received placebo consisting of plain juice. All three groups also received the hospital's current standard treatment for procedural pain in BMAs. Patients and caregivers assessed the procedural pain, as did the performing doctors. For the patients, Faces Pain Scale – Revised was used and the Numeric Rating Scale-11 for caregivers and doctors. Results: A total of 87 patients were included in the study distributed with 29 in Group K, 29 in Group KM, and 29 in Group P. Seven patients were excluded, one patient denied participation and the remaining did not meet the inclusion criteria. There was no significant difference between the pain reported by the groups. A total of 69% patients in Group KM and 35% in Group K had somnolence reported as a side effect compared to 14% in Group P. Conclusion: We found no significant effects on the procedural pain in any of the treatment groups compared to placebo. There were only mild side effects. The doses of ketamine might be insufficient for this painful and stressful procedure.
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Affiliation(s)
- Spandana Rayala
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | | | - Vikranth Haridass
- Department of Pain Relief and Palliative Care Society, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Gayatri Palat
- Department of Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India.,Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada.,Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Axel Ström
- Skane University Hospital, Clinical Studies Sweden-Forum South, Lund, Sweden
| | - Thomas Wiebe
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - Eva Brun
- Department of Clinical Sciences, Oncology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiotherapy and Radiophysics, Skane University Hospital, Lund, Sweden
| | - Mikael Segerlantz
- Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University, Region Skane, Lund, Sweden.,Palliative Care and Advanced Home Health Care, Primary Health Care Skane, Region Skane, Lund, Sweden
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Flores-González JC, Lechuga-Sancho AM, Saldaña Valderas M, Jimenez Gomez G, Cruzado García MD, Pérez Aragón C, Blanca García JA. Respiratory adverse events during upper digestive endoscopies in children under ketamine sedation. Minerva Pediatr (Torino) 2017; 73:15-21. [PMID: 28176512 DOI: 10.23736/s2724-5276.16.04758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is no evidence of the need for oxygen supplementation during upper digestive endoscopies under ketamine sedation in children, and the latest recommendations specifically state that it is not mandatory for the procedure. The aim of our study is to assess the incidence of respiratory adverse events during upper digestive endoscopies in children under Ketamine sedation when performed without oxygen supplementation, in accordance with the latest recommendations. METHODS Eighty-eight children undergoing ketamine sedation for programmed upper digestive endoscopy at our Pediatric Intensive Care Unit were included. Patients needing other sedative agents different from ketamine were excluded. No patients received previous oxygen therapy. Suction equipment, oxygen, a bag-valve-mask, and age-appropriate equipment for advanced airway management were immediately available. The primary outcome measure was the incidence of desaturation episodes (i.e. FiO<inf>2</inf> below 90% requiring an intervention). RESULTS Fifty-five patients (62.5%) presented a desaturation episode during the procedure. Most desaturation episodes occurred during the endoscope introduction (78.2%), and 5 episodes were previous to the endoscope introduction (minute 0). Around sixty percent of patients (58.9%) required oxygen therapy and four patients required bag-mask ventilation. Once oxygen therapy was initiated, 34 patients (70.5%) required it during the complete procedure or part of it. CONCLUSIONS Desaturation episodes occur frequently early on in the procedure. Our data suggest that the role of oxygen supplementation prior to, and during upper digestive endoscopies under ketamine sedation in children should be thoroughly assessed for future recommendations.
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Affiliation(s)
| | - Alfonso M Lechuga-Sancho
- Department of Mother and Child Health, University of Cadiz, Cadiz, Spain.,Department of Radiology, University of Cadiz, Cadiz, Spain
| | | | | | | | - Cristina Pérez Aragón
- Unit of Pediatric Gastroenterology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Jose A Blanca García
- Unit of Pediatric Gastroenterology, Puerta del Mar University Hospital, Cadiz, Spain
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Procedural Sedation Outside of the Operating Room Using Ketamine in 22,645 Children: A Report From the Pediatric Sedation Research Consortium. Pediatr Crit Care Med 2016; 17:1109-1116. [PMID: 27505716 PMCID: PMC5138082 DOI: 10.1097/pcc.0000000000000920] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Most studies of ketamine administered to children for procedural sedation are limited to emergency department use. The objective of this study was to describe the practice of ketamine procedural sedation outside of the operating room and identify risk factors for adverse events. DESIGN Observational cohort review of data prospectively collected from 2007 to 2015 from the multicenter Pediatric Sedation Research Consortium. SETTING Sedation services from academic, community, free-standing children's hospitals and pediatric wards within general hospitals. PATIENTS Children from birth to 21 years old or younger. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Describe patient characteristics, procedure type, and location of administration of ketamine procedural sedation. Analyze sedation-related adverse events and severe adverse events. Identify risk factors for adverse events using multivariable logistic regression. A total of 22,645 sedations performed using ketamine were analyzed. Median age was 60 months (range, < 1 mo to < 22 yr); 72.0% were American Society of Anesthesiologists-Physical Status less than III. The majority of sedations were performed in dedicated sedation or radiology units (64.6%). Anticholinergics, benzodiazepines, or propofol were coadministered in 19.8%, 57.9%, and 35.4%, respectively. The overall adverse event occurrence rate was 7.26% (95% CI, 6.92-7.60%), and the frequency of severe adverse events was 1.77% (95% CI, 1.60-1.94%). Procedures were not completed in 39 of 19,747 patients (0.2%). Three patients experienced cardiac arrest without death, all associated with laryngospasm. CONCLUSIONS This is a description of a large prospectively collected dataset of pediatric ketamine administration predominantly outside of the operating room. The overall incidence of severe adverse events was low. Risk factors associated with increased odds of adverse events were as follows: cardiac and gastrointestinal disease, lower respiratory tract infection, and the coadministration of propofol and anticholinergics.
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Barzegari H, Masoumi K, Motamed H, Zohrevandi B, Zeynadini Meymand S. Comparing Two Different Doses of Intravenous Midazolam in Pediatric Sedation and Analgesia. EMERGENCY (TEHRAN, IRAN) 2016; 4:192-195. [PMID: 27800539 PMCID: PMC5007910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard. METHODS The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22. RESULTS 110 infants with the mean age of 14.0 ± 5.9 months (range: 4 - 24) and mean weight of 9.7 ± 2 kg (range: 5 - 15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg/kg groups were 38.2% (21 patients) and 60% (33 patients), respectively (p = 0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1 ± 1.1 mg). CONCLUSION The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg/kg midazolam compared to 0.1 mg/kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects.
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Affiliation(s)
- Hassan Barzegari
- Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran
| | - Kambiz Masoumi
- Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran.,Corresponding Author: Department of Emergency Medicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University of Medical Sciences, Azadegan Avenue, Ahvaz, Khuzestan Province 6193673166, Iran; Tel/Fax: +986112229166;
| | - Hassan Motamed
- Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran
| | - Behzad Zohrevandi
- Road trauma Research Center, Guilan University ofMedical Sciences, Rasht, Iran
| | - Shima Zeynadini Meymand
- Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran
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Kalibatienė L, Kalibatas V, Macas A, Trepenaitis D. An evaluation of the effectiveness and safety of midazolam in children undergoing dental surgery. MEDICINA-LITHUANIA 2015; 51:180-186. [PMID: 28705481 DOI: 10.1016/j.medici.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 04/04/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness and safety of oral midazolam in children undergoing dental surgery. MATERIALS AND METHODS A prospective, randomized, controlled trial was conducted to assess the effectiveness and safety of midazolam in children. Patients aged 2-9 years who underwent dental surgery under general anesthesia were randomly allocated into one of the four groups: midazolam 0.2mg/kg dose group (n=30); midazolam 0.21-0.4mg/kg dose group (n=15); midazolam more than 0.41mg/kg dose group (n=15) or the placebo group (n=31). The effectiveness of midazolam on sedation was assessed by the evaluation of vital signs, such as the respiratory and heart rate, oxygen saturation and the patients' reactive behaviors, in comparison with the placebo. RESULTS The scores of the ratings for sleep, movement and crying, as well as patients' reactions at the moment of separation from their parents and their collaboration with the staff were statistically significantly better among patients who received oral midazolam compared with the placebo. There were statistically significant direct correlations between the doses of midazolam and higher sleep, movement, crying and reaction scores 30min after premedication as well as higher scores of patients upon separation from their parents. There were only a few clinically insignificant side effects. CONCLUSIONS Oral midazolam, at a single dose from 0.2 to 0.6mg/kg, is effective and safe, and provides the expected sedative effects in children required by premedication for dental surgery.
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Affiliation(s)
- Lina Kalibatienė
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Vytenis Kalibatas
- Department of Health Management, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Andrius Macas
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Darius Trepenaitis
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Chéron G. [Sedation and analgesia in emergency structure. Paediatry: Which sedation and analgesia for the child under spontaneous ventilation?]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:369-76. [PMID: 22464837 DOI: 10.1016/j.annfar.2012.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G Chéron
- Département des urgences pédiatriques, université Paris Descartes Paris-V, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75730 Paris cedex 15, France.
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Orliaguet G. Sédation et analgésie en structure d’urgence. Pédiatrie : quelle sédation et analgésie pour l’intubation trachéale chez l’enfant ? ACTA ACUST UNITED AC 2012; 31:377-83. [DOI: 10.1016/j.annfar.2012.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Orliaguet G. [Sedation and analgesia in emergency structure. Paediatry: Which sedation and analgesia for pediatric patients? Pharmacology]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:359-368. [PMID: 22445224 DOI: 10.1016/j.annfar.2012.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- G Orliaguet
- Département d'anesthésie-réanimation, hôpital Necker-Enfants-malades, université Paris Descartes, Paris 5, 149, rue de Sèvres, 75730 Paris cedex 15, France.
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Moy R, Le Clerc S. Ketamine in prehospital analgesia and anaesthesia. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2011. [DOI: 10.1016/j.tacc.2011.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
AbstractInvasive procedures, such as the lumbar puncture, can cause anxiety and pain in children undergoing treatment for acute lymphoblastic leukemia (ALL). We investigated the safety and efficacy of two different protocols for pain relief in 20 children with ALL undergoing lumbar puncture. Protocol A was composed of an association between propofol and alfentanil. Protocol B consisted in the combination of propofol and ketamine. Vital and behavioural parameters, sedation and pain scores were recorded at different times during and after the procedure. All patients showed a satisfactory sedation and analgesia. We found a statistically significant difference of vital parameters between protocol A and protocol B, while there were no significative differences between sedation scores and the other parameters evaluated. Patients in protocol A showed a higher incidence of major side effects, such as respiratory depression. Our results show that both protocols are effective to obtain a good sedation and analgesia in children with ALL undergoing lumbar puncture, but the association between propofol and ketamine appears more safe due to the lower incidence of side effects.
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