title: S(+)-ketamine for rectal premedication in children.
abstract: Our purpose for this prospective, randomized, and double-blinded study was to evaluate the anesthetic efficacy of S(+)-ketamine, an enantiomer of racemic ketamine, compared with a combination of S(+)-ketamine and midazolam, and plain midazolam for rectal premedication in pediatric anesthesia. Sixty-two children, ASA physical status I and II, scheduled for minor surgery, were randomly assigned to be given rectally one of the following: 1.5 mg/kg preservative-free S(+)-ketamine, a combination of 0.75 mg/kg preservative-free S(+)-ketamine and 0.75 mg/kg midazolam, or 0.75 mg/kg midazolam. Preoperative anesthetic efficacy was graded during a period of 20 min by using a five-point scale from 1 = awake to 5 = asleep. Tolerance during anesthesia induction via face mask was graded by using a four-point scale from 1 = very good to 4 = bad. A sufficient anesthetic level (> or = 3) after rectal premedication was reached in 86% in midazolam/S(+)-ketamine premedicated children, in 75% in midazolam premedicated children, but only in 30% in S(+)-ketamine premedicated children (P < 0.05 S(+)-ketamine versus midazolam/S(+)-ketamine and midazolam groups). The incidence of side effects after rectal premedication was rare. Whereas the mask acceptance score was comparable in the three study groups, a 25% rate of complications during anesthesia induction via face was observed in the S(+)-ketamine study group (P < 0.05 versus other study groups). Our conclusions are that S(+)-ketamine for rectal premedication in the dose we chose shows a poor anesthetic effect and a frequent incidence of side effects during induction of anesthesia via face mask compared with the combination of midazolam/S(+)-ketamine and plain midazolam. Dose-response studies of S(+)-ketamine for rectal premedication in pediatric anesthesia may be warranted.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University of Vienna Medical School, Vienna, Austria. peter.marhofer@univie.ac.at
authors.forename: P
authors.initials: P
authors.lastname: Marhofer
authors.forename: H
authors.initials: H
authors.lastname: Freitag
authors.forename: A
authors.initials: A
authors.lastname: Höchtl
authors.forename: M
authors.initials: M
authors.lastname: Greher
authors.forename: W
authors.initials: W
authors.lastname: Erlacher
authors.forename: M
authors.initials: M
authors.lastname: Semsroth
mesh_terms: D000285:Administration, Rectal; D000769:Anesthesia, Inhalation; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000009:adverse effects; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects; D002675:Child, Preschool; D016292:Procedural Sedation; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008874:Midazolam / Q000008:administration & dosage; D011229:Preanesthetic Medication; D011446:Prospective Studies; D013237:Stereoisomerism
chemical_list: D000778:Anesthetics, Dissociative; D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam