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Lytic cocktail in children. Rectal versus intramuscular administration
M Laub1, P Sjøgren, R Holm-Knudsen
1Department of Anaesthesia, Gentofte Hospital, University of Copenhagen, Denmark.
Insights
The lytic cocktail effectively sedated children before surgery. However, rectal administration resulted in less postoperative sedation compared to intramuscular, suggesting a need for higher rectal doses for prolonged effects.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Surgical Premedication
Background:
- Premedication is crucial for managing pediatric anxiety and pain during surgical procedures.
- The lytic cocktail, a combination of pethidine, promethazine, and chlorpromazine, is used for sedation.
- Evaluating different administration routes is important for optimizing efficacy.
Purpose of the Study:
- To compare the efficacy of intramuscular versus rectal administration of the lytic cocktail as premedication in children undergoing minor otological surgery.
- To assess sedation levels and plasma pethidine concentrations following different administration routes.
Main Methods:
- A study involving 51 children aged 1-12 years undergoing elective otological surgery.
- Two groups received the lytic cocktail: one intramuscularly (0.05 ml/kg) and the other rectally (0.07 ml/kg).
- Sedation levels were assessed pre- and post-operatively, with plasma pethidine concentrations measured.
Main Results:
- Both intramuscular and rectal administration provided satisfactory pre-operative sedation.
- Children who received the lytic cocktail rectally exhibited less post-operative sedation compared to the intramuscular group.
- Lower plasma pethidine concentrations were observed in the rectal administration group.
Conclusions:
- Intramuscular administration of the lytic cocktail appears more effective for achieving prolonged postoperative sedation in pediatric patients.
- Rectal administration may require a higher dosage to achieve comparable or extended sedation levels post-operatively.
- Further research into optimized rectal dosing is warranted for effective pediatric premedication.
Abstract:
The efficacy of the lytic cocktail (1 ml contains pethidine 28 mg, promethazine 7 mg, chlorpromazine 7 mg) administered intramuscularly or rectally as premedication was studied in 51 children aged 1-12 years who had minor elective otological surgery. One group received 0.05 ml/kg intramuscularly (maximum dose 2.0 ml) and the other 0.07 ml/kg per rectum (maximum dose 2.8 ml). Most were satisfactorily sedated before operation, but after operation the rectally premedicated children were less sedated, which was in agreement with lower plasma pethidine concentrations in this group. The rectal dose should be increased if prolonged postoperative sedation is desireable.