The Clinical Effects of Adjunctive Mida zolam During Ketamine Procedural Sedation in Pediatric Emergency Patients

Lee, Jin Hee; You, Je Sung; Cho, Young Soon; Yoon, Yoo Sang; Park, Jun Seok; Lee, Hahn Shick; Cho, Kwang Hyun

Abstract

PURPOSE
Despite widespread use of adjunctive benzodiazepines during ketamine sedation, their efficacy in children has never been studied in Korea. We compared the clinical characteristics and the side effects of as well as the physic i a n's satisfaction with, ketamine sedation in pediatric patients undergoing procedures involving ketamine with adjunctive midazolam.
METHODS
The study was a prospective, randomized, clinical evaluation of the effect of adjunctive midazolam during ketamine sedation. We enrolled 60 children aged 8 months to 8 years. Subjects received either intramuscular ketamine (3 mg/kg) with atropine (0.01 mg/kg) (KA) or intramuscular midazolam (0.05 mg/kg) with ketamine and atropine (KMA). For the two groups, we evaluated the induction time, the recovery time, the sedation efficacy, the adverse effects, and the treating physicians' satisfaction.
RESULTS
Forty-two (42) subjects received KMA, and 18 received KA. Potentially confounding variables were similar between the two groups, and the induction times and the recovery times were equivalent. The addition of midazolam led to better sedation efficacy (KA=18.8% versus KMA= 55.0%), more treating physician satisfaction (KA=35.4% versus KMA=69.2%), and a decreased incidence of recovery agitation (KA=27.8% versus KMA= 4.7%).
CONCLUSION
The incidence of emergence phenomena and satisfaction was affected by the addition of midazolam. The addition of midazolam during ketamine sedation is efficacious and safe with high physician satisfaction for sedation of pediatric patients in the Emergency Department.