Long term high dose morphine, ketamine and midazolam infusion in a child with burns

The metabolism of morphine and ketamine was studied in a 14 month old child with extensive burns, who received infusions of both drugs for more than 30 days. The mean plasma clearance of morphine was 29 ml min-1 kg-1 and the plasma ratios of morphine-6-glucuronide to morphine were similar to those previously reported in children. The mean plasma clearance of ketamine was 32 ml min-1 kg-1 which is greater than that previously reported in older children and adults. There were no complications despite high dose long term therapy with morphine, ketamine and midazolam.