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Bioavailability studies are essential for understanding how a drug is absorbed, distributed, metabolized, and excreted in the body. These studies assess the extent and rate at which the active pharmaceutical agent becomes available at the site of action. The design of bioavailability studies can involve single-dose or multiple-dose regimens, each with distinct advantages and limitations.Single-dose studies are the preferred approach due to their simplicity and reduced drug exposure for...
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Rectal temperature measurement is considered the most precise method for assessing core body temperature and typically registers higher than oral temperature. For adults, the rectal thermometer should be inserted 1 to 1.5 inches into the rectum to obtain the most accurate reading.
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Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study.

Benjamin Grossmann1, Andreas Nilsson2, Folke Sjöberg3

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Rectal ketamine and midazolam effectively manage pain during pediatric burn dressing changes. A 6mg/kg ketamine dose with 0.5mg/kg midazolam offers optimal pain relief, feasibility, and safety.

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Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Pharmacology

Background:

  • Ketamine is widely used in pediatric procedures, but specific dosing recommendations for rectal administration during painful procedures like burn wound care are lacking.
  • High pain and anxiety levels during procedures necessitate effective and safe sedation strategies for children.

Purpose of the Study:

  • To evaluate the efficacy and safety of different single doses of rectally administered racemic ketamine combined with midazolam for pediatric burn dressing changes.
  • To determine the optimal dose of rectal ketamine for procedural pain management in children aged 6 months to 4 years.

Main Methods:

  • A randomized controlled trial involving 90 children (6 months to 4 years) receiving rectally administered racemic ketamine (4, 6, or 8 mg/kg) with a fixed dose of midazolam (0.5 mg/kg).
  • Procedural pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale.
  • Feasibility, recovery time, and patient safety were evaluated as secondary outcomes.

Main Results:

  • All tested doses (4, 6, and 8 mg/kg ketamine) resulted in minimal procedural pain (median FLACC score of 0).
  • The 6 mg/kg and 8 mg/kg ketamine groups showed better feasibility compared to the 4 mg/kg group.
  • The 6 mg/kg ketamine group had no need for rescue analgosedative medication and demonstrated optimal recovery time and safety.

Conclusions:

  • A combination of 6 mg/kg racemic ketamine and 0.5 mg/kg midazolam administered rectally provides optimal conditions for pediatric burn dressing procedures.
  • This regimen ensures effective pain relief, good feasibility, acceptable recovery times, and patient safety without requiring additional sedation medication.