An alternative to "brutacaine": a comparison of low dose intramuscular ketamine with intranasal midazolam in children before suturing.
OBJECTIVE
To compare the use of low dose intramuscular ketamine with high dose intranasal midazolam in children before suturing.


METHODS
Altogether 102 children with simple wounds between 1 and 7 years old were allocated to the two study groups.


RESULTS
Two children were excluded from the study because of deviation from the agreed protocol. The 50 children in the ketamine group were less likely to cry or need to be restrained during the procedure than those in the midazolam group (p < 0.01). The median oxygen saturation was 97% in both groups. There was no difference in the recovery behaviour and the range of time at which children were ready for discharge, although the median time for the latter was shorter in the midazolam group (75 v 82 minutes). Vomiting occurred in nine of the ketamine and four of the midazolam group. After discharge both groups had an unsteady gait (73% v 71%) which usually resolved within two hours.


CONCLUSIONS
Intranasal midazolam (0.5 mg/kg) effectively sedated the children in that none could remember the suturing. However a significant number still had to be restrained (86% v 14%). Intramuscular ketamine (2.5 mg/kg) produced dissociative anaesthesia in the majority of cases and was the preferred drug of nurse, doctor, and parent.
Accident and Emergency Department, Royal Lancaster Infirmary.
R G
RG
McGlone
S
S
Ranasinghe
S
S
Durham
D000281:Administration, Intranasal; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000009:adverse effects; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013537:Sutures; D014947:Wounds and Injuries / Q000628:therapy*
D000778:Anesthetics, Dissociative; D014151:Anti-Anxiety Agents; D007649:Ketamine; D008874:Midazolam