All issues > Volume 49(7); 2006

Original Article

Korean J Pediatr. 2006;49(7):726-731. Published online July 15, 2006.

The efficacy of optimal doses of intramuscular ketamine and midazolam injections for procedural sedation in laceration repair of children

Je Sung JS You¹, Young Soon YS Cho², Young Hwan YH Choi¹, Seung Hwan SH Kim¹, Hahn Shick HS Lee¹, Jin Hee JH Lee¹

¹Department of Emergency Medicine, Yonsei University College of Medicine, Seoul
²Department of Emergency Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea

Correspondence Jin Hee JH Lee ,Email: gienee@yumc.yonsei.ac.kr

Abstract

Purpose
: We reported previously that intramuscular ketamine with adjunctive midazolam is more effective than ketamine alone in pediatric procedural sedation, but with limited satisfactory sedation by suboptimal ketamine dose. The optimal dose of intramuscular ketamine in children has never been studied in Korea. In this study, we investigated the effectiveness and adverse events of ketamine 4mg/kg with adjunctive midazolam in pediatric laceration repair.
Methods
: From Jan. 2005 to July 2005, we enrolled 60 children, aged 3 months-7 years, who needed laceration repair under sedation. After verbal consent from parents, patients were randomly assigned to KMA group(IM ketamine 4 mg/kg＋atropine 0.01 mg/kg＋intramuscular midazolam 0.05 mg/kg) or KA group(without midazolam). We compared both groups with the induction time, recovery time, total sedation time, efficacy of sedation, adverse effects, and the satisfaction score of treating physicians.
Results
: Potentially confounding variables, age, weight, injury site and anxiety score, were similar between groups. The induction time, recovery time and total sedation time were not different statistically. In KMA group, 90.9 percent of patients showed satisfactory sedation compared to 66.7 percent of KA group(P=0.02) and the occurrence rate of significant adverse effect was 0.0 percent and 37.0 percent respectively.
Conclusion
: We found adjunctive midazolam with ketamine doses of 4 mg/kg IM produced more effective, satisfactory sedation and less adverse effect than without midazolam in pediatric laceration repair. The emergence phenomenon(agitation during recovery) only occurred in 9 KA group patients. In spite of adverse effect, all patients recovered, were discharged and there were no reported delayed events.

Keywords :Ketamine , Midazolam , Conscious sedation