Ketamine-midazolam versus meperidine-midazolam for painful procedures in pediatric oncology patients
| Autor: | J Stein, J L Blumer, M L Nieder, C M Marx, M K Tyler, S B Shurin |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Meperidine Biopsy Midazolam Child Behavior Spinal Puncture law.invention Randomized controlled trial Double-Blind Method law Medicine Humans Hypnotics and Sedatives Ketamine Child Anesthetics Cross-Over Studies medicine.diagnostic_test business.industry Lumbar puncture Bone Marrow Examination Crossover study Surgery Pethidine Regimen Oncology Anesthesia Child Preschool Premedication Female business medicine.drug |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 15(1) |
| ISSN: | 0732-183X |
| Popis: | PURPOSE To compare the efficacy, characteristics of onset/recovery, and safety of ketamine/atropine/midazolam with meperidine/midazolam used as premedication for painful procedures in children with cancer. METHODS A randomized, double-blind crossover trial for two successive painful procedures (bone marrow aspiration or biopsy, lumbar puncture, or combined procedures) was performed at a referral-based pediatric hematology-oncology clinic and associated inpatient service of a university teaching hospital. Twenty-two children, aged 24 to 178 months, were enrolled and 18 (81.8%) completed the double-blind, crossover trial. Each child received intravenous premedication with either meperidine 2 mg/kg and midazolam 0.1 mg/kg (MM) or atropine 0.01 mg/kg, midazolam 0.05 mg/kg, and ketamine 1.5 mg/kg (KM) on one occasion followed by the alternative regimen on a second occasion. The initial premedication regimen was chosen by random assignment. RESULTS Efficacy was assessed by a trained observer using the Observational Scale of Behavioral Distress-Revised (OSBD-R). Operator, nurse, parent, and patient opinions of efficacy were recorded on a visual analog scale (VAS). Side effects were monitored by pulse oximetry, nasal end-tidal capnography, and serial blood pressure measurements. Use of KM resulted in significantly less procedural distress than MM (1.37 +/- 2.20 v 7.04 +/- 8.06 OSBD-R units; P < .05). Both operators and nurses rated KM more effective than MM. KM use was associated with earlier readiness for the procedure (19.2 v 24.0 minutes) and more rapid recovery (39.3 v 74.6 minutes for removal of monitoring devices and 58.5 v 87.1 minutes for discharge). Procedures undertaken after ketamine sedation were associated with fewer side effects than observed with MM sedation (hypoxia, 17.7% v 82.4%; hypotension, 16.6% v 55.6%; reduced respiratory rate, 0% v 38.9%). The incidence of emergence reactions or behavioral abnormalities within 24 hours postprocedure was similar in both treatment groups. At 7 days postprocedure, no child had persistent behavioral abnormalities and all children had amnesia for the procedure. Parents and children expressed a preference for KM over MM in 12 of 18 cases (P < .05). CONCLUSION A premedication regimen of KM produced superior sedation with a faster onset and recovery and fewer side effects than a MM combination. |
| Databáze: | OpenAIRE |
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