title: Use of midazolam and ketamine as sedation for children undergoing minor operative procedures.
abstract: OBJECTIVE
  We used intravenous midazolam and ketamine for children undergoing minor operative procedures with satisfactory results. We aimed to further evaluate its efficacy and adverse effects in pediatric ward setting.
  
  
  METHODS
  This was a prospective study of all children undergoing minor operations with sedation in our pediatric general and oncology wards from July 1998 to June 1999. The procedures included lumber puncture+/-intrathecal chemotherapy, bone marrow aspiration+/-trephine biopsy, central venous catheter removal, skin biopsy, or their combination. All sedation procedures were started with midazolam 0.1 mg/kg and ketamine 1 mg/kg; they were increased gradually to 0.4 and 4 mg/kg, respectively, if necessary. Heart rate and SaO2 were continuously monitored.
  
  
  RESULTS
  Altogether, 369 minor operations were performed in 112 patients (male:female=2:1, median age 6 years, range 5 months-17 years). All achieved adequate sedation, with 96% within 30 s and 75% required just the starting dose. Younger children required a higher dosage (p=0.003 for midazolam, p<0.001 for ketamine). The median recovery time was 87 min, with no association with age, sex, or dosage of sedation, but was longer in patients having hallucination (p=0.001). Adverse effects included tachycardia (27.9%), increased secretion (17.6%), agitation (13.6%), nausea and vomiting (9.2%), hallucination (8.7%), desaturation (8.4%), and cataleptic reaction (0.8%). All desaturation episodes were transient and responded to oxygen supplement alone. None developed bronchospasm or convulsion. Some adverse effects were dose-related. Half of the children who received 0.3 mg/kg midazolam developed desaturation.
  
  
  CONCLUSIONS
  Intravenous midazolam-ketamine can provide rapid, effective, and safe sedation for children undergoing minor operations in ward setting. Adverse effects are mild. Midazolam above 0.3 mg/kg should be used with caution.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, 121 Pokfulam Road, Hong Kong, Hong Kong. gcfchan@hkucc.hku.hk
authors.forename: D K L
authors.initials: DK
authors.lastname: Cheuk
authors.forename: W H S
authors.initials: WH
authors.lastname: Wong
authors.forename: E
authors.initials: E
authors.lastname: Ma
authors.forename: T L
authors.initials: TL
authors.lastname: Lee
authors.forename: S Y
authors.initials: SY
authors.lastname: Ha
authors.forename: Y L
authors.initials: YL
authors.lastname: Lau
authors.forename: G C F
authors.initials: GC
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D006723:Hong Kong; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008495:Medical Oncology; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013511:Minor Surgical Procedures; D011446:Prospective Studies
chemical_list: D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam