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Sedation for pediatric procedures, using ketamine and midazolam, in a primarily adult intensive care unit: a
1Critical Care Medicine Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892-1662, USA.
Insights
Ketamine and midazolam provide safe and effective anesthesia for pediatric procedures outside the operating room. Experienced practitioners can minimize complications, reducing patient anxiety and discomfort during interventions.
Area of Science:
- Pediatric Critical Care Medicine
- Anesthesiology
- Pharmacology
Background:
- Pediatric procedures often require anesthesia and sedation.
- Adult critical care practitioners can manage pediatric patients.
- Ketamine and midazolam are commonly used anesthetic agents.
Purpose of the Study:
- To evaluate the effectiveness and safety of ketamine and midazolam for pediatric procedural sedation.
- To assess the role of adult critical care practitioners in administering these agents.
Main Methods:
- Retrospective case series of 127 pediatric patients (1-18 years).
- Procedures included lumbar puncture, bone biopsy, central line placement, liver biopsy, thoracentesis, and bone marrow aspiration/biopsy.
- Intravenous ketamine and midazolam administered and titrated to effect in an ICU sedation area.
Main Results:
- 295 procedures were performed with ketamine and midazolam.
- Nine complications occurred: oxygen desaturation (n=1), vital sign alterations (n=3), rash (n=2), dizziness (n=1), wheezing (n=1), and emergence reaction (n=1).
- No patient required ICU admission due to complications; no bradycardia or cardiopulmonary compromise observed.
Conclusions:
- Ketamine and midazolam sedation is effective and safe for pediatric procedures outside the OR.
- Experienced personnel, including non-pediatricians, can administer this combination.
- This approach reduces patient anxiety and discomfort with a low incidence of side effects.
Objective:
To evaluate the effectiveness and safety of pediatric procedures performed by adult critical care practitioners, using the combination of ketamine and midazolam for anesthesia and sedation.
Design:
A retrospective case series.
Setting:
The intensive care unit (ICU) of a 325-bed tertiary research hospital.
Patients:
Individuals from 1 to 18 yrs of age who had intravenous midazolam sedation and ketamine anesthesia administered while undergoing lumbar puncture, bone biopsy, central venous catheter placement, liver biopsy, thoracentesis, or bone marrow aspirate/biopsy.
Interventions:
None.
Measurements And Main Results:
A retrospective chart review was performed. The dosages of medications used were tabulated, and milligram per kilogram dosages were calculated. The procedures performed, their durations, and any complications of the anesthesia and sedation were noted. These complications included: oxygen desaturations <90%, vital sign alterations requiring intervention, rashes, subjective complaints of dizziness by the patient, and emergence reactions to ketamine. A total of 127 pediatric patients were admitted to the ICU sedation area for a total of 295 procedures. All patients received ketamine and midazolam intravenously in divided doses and titrated to effect. A total of nine complications were observed. These complications included oxygen desaturation <90% (n = 1), vital sign alterations requiring treatment (n = 3), rash (n = 2), dizziness (n = 1), wheezing (n = 1), and emergence reaction (n = 1). No patient required admission to the ICU because of a complication. There were no episodes of bradycardia or other cardiopulmonary compromise.
Conclusions:
Pediatric anesthesia and sedation, using ketamine and midazolam, can be performed in a designated monitored setting, outside of the operating room, by experienced personnel, including nonpediatricians. This therapeutic combination allows painful procedures to be performed with less anxiety and discomfort. In experienced hands, a limited number of side effects occur.
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