title: Oral ketamine/midazolam is superior to intramuscular meperidine, promethazine, and chlorpromazine for pediatric cardiac catheterization.
abstract: An IM combination of meperidine, promethazine, and chlorpromazine (DPT) has been given as sedation for pediatric procedures for more than 40 years. We compared this IM combination to oral (PO) ketamine/midazolam in children having cardiac catheterization. A total of 51 children, ages 9 mo to 10 yr, were enrolled and randomized in this double-blinded study. All children received an IM injection at time zero and PO fluid 15 minutes later. We observed acceptance of medication, onset of sedation and sleep, and sedative efficacy. The cardiorespiratory changes were evaluated. Sedation was supplemented with IV propofol as required. Recovery time, parental satisfaction, and patient amnesia were assessed. Ketamine/midazolam given PO was better tolerated (P < 0.0005), had more rapid onset (P < 0.001), and provided superior sedation (P < 0.005). Respiratory rate decreased after IM DPT only. Heart rate and shortening fraction were stable. Oxygen saturation and mean blood pressure decreased minimally in both groups. Supplemental propofol was more frequently required (P < or = 0.02) and in larger doses (P < 0.05) after IM DPT. Parental satisfaction ratings were higher (P < 0.005) and amnesia was more reliably obtained (P = 0.007) with PO ketamine/midazolam. Two patients needed airway support after the PO medication, as did two other patients when PO ketamine/midazolam was supplemented with IV propofol. Although PO ketamine/midazolam provided superior sedation and amnesia compared to IM DPT, this regimen may require the supervision of an anesthesiologist for safe use.
  
  
  CONCLUSIONS
  Oral medication can be superior to IM injections for sedating children with congenital heart disease; however, the safety of all medications remains an issue.
authors.affiliation: Departments of Anesthesiology, Pediatrics, and Family and Community Medicine of the University of Louisville and Kosair Children's Hospital, Louisville, KY 40202, USA. sauden@aol.com
authors.forename: S M
authors.initials: SM
authors.lastname: Auden
authors.forename: W L
authors.initials: WL
authors.lastname: Sobczyk
authors.forename: R E
authors.initials: RE
authors.lastname: Solinger
authors.forename: L J
authors.initials: LJ
authors.lastname: Goldsmith
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects; D000284:Administration, Oral; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D002746:Chlorpromazine / Q000008:administration & dosage / Q000009:adverse effects; D004311:Double-Blind Method; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007223:Infant; D007273:Injections, Intramuscular; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D011398:Promethazine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008614:Meperidine; D011398:Promethazine; D008874:Midazolam; D002746:Chlorpromazine