Pretreatment with small-dose ketamine reduces withdrawal movements associated with injection of rocuronium in pediatric patients.
We evaluated the pretreatment of small-dose of ketamine or normal saline in the reduction of withdrawal movements induced by rocuronium injection. One-hundred pediatric patients (aged 1-6 yr) were randomly assigned into 2 groups. A 22-gauge IV cannula was inserted into the dorsum of the hand, and ketamine 0.2 mg/kg or normal saline was given, followed by a 5 mg/kg thiopental injection 10 s later. IV rocuronium (0.8 mg/kg) was injected over 5 s. The patient's response to rocuronium injection was graded by using a four-point scale in a double-blinded manner. We observed that the incidence of withdrawal movements was 83% in the saline group and 27% in patients pretreated with ketamine (P < 0.05). Some patients in both groups developed skin erythema at the site of injection. We conclude that pretreatment with small-dose ketamine significantly attenuates withdrawal movements associated with IV injection of rocuronium in pediatric patients anesthetized with thiopental.


CONCLUSIONS
Pretreatment with small-dose ketamine 0.2 mg/kg provides a simple and safe means of reducing the incidence of withdrawal movements induced by the injection of rocuronium, a short-acting nondepolarizing muscle relaxant.
Department of Anesthesiology, Chang Gung Memorial Hospital, and Chang Gung University, Taoyuan, Taiwan.
Jiin-Tarng
JT
Liou
Jee-Ching
JC
Hsu
Fu-Chao
FC
Liu
Daniel
D
Ching-Wah Sum
Ping-Wing
PW
Lui
D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects*; D000778:Anesthetics, Dissociative / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004890:Erythema / Q000139:chemically induced / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous / Q000009:adverse effects*; D007649:Ketamine / Q000494:pharmacology*; D008297:Male; D009068:Movement / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects*; D011229:Preanesthetic Medication; D000077123:Rocuronium; D012867:Skin / Q000473:pathology
D000732:Androstanols; D000778:Anesthetics, Dissociative; D003473:Neuromuscular Nondepolarizing Agents; D007649:Ketamine; D000077123:Rocuronium