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S(+)-ketamine for rectal premedication in children.
P Marhofer1, H Freitag, A Höchtl
1Department of Anaesthesia and Intensive Care Medicine, University of Vienna Medical School, Vienna, Austria. peter.marhofer@univie.ac.at
Anesthesia and Analgesia
|January 3, 2001
Summary
Rectal S(+)-ketamine showed poor anesthetic effects and more side effects in pediatric anesthesia. A combination of S(+)-ketamine and midazolam, or midazolam alone, provided better results for rectal premedication.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Rectal premedication is used in pediatric anesthesia to reduce anxiety and improve cooperation.
- S(+)-ketamine, an enantiomer of ketamine, has anesthetic properties but its efficacy via rectal administration in children requires evaluation.
- Midazolam is a commonly used sedative and anxiolytic agent in pediatric premedication.
Purpose of the Study:
- To compare the anesthetic efficacy of rectal S(+)-ketamine versus a combination of S(+)-ketamine and midazolam, and plain midazolam for pediatric anesthesia.
- To assess the tolerance and complications during anesthesia induction via face mask following different rectal premedication regimens.
Main Methods:
- Prospective, randomized, double-blinded study involving 62 children (ASA I-II) undergoing minor surgery.
- Children received one of three rectal premedications: S(+)-ketamine (1.5 mg/kg), S(+)-ketamine (0.75 mg/kg) + midazolam (0.75 mg/kg), or midazolam (0.75 mg/kg).
- Anesthetic efficacy, mask acceptance, and complications during induction were assessed using standardized scales.
Main Results:
- A sufficient anesthetic level was achieved in 86% of children receiving midazolam/S(+)-ketamine, 75% with midazolam, and only 30% with S(+)-ketamine (P < 0.05).
- Mask acceptance scores were similar across groups, but S(+)-ketamine alone resulted in a 25% complication rate during mask induction (P < 0.05).
- The incidence of side effects after rectal premedication was generally rare.
Conclusions:
- Rectal S(+)-ketamine, at the tested dose, demonstrated inadequate anesthetic effect and a higher incidence of induction complications compared to midazolam or midazolam/S(+)-ketamine combinations.
- Further dose-response studies of S(+)-ketamine for rectal premedication in pediatric anesthesia may be beneficial.
- Combination therapy with midazolam and S(+)-ketamine appears to be a more effective rectal premedication strategy in pediatric anesthesia.