title: Sedation with intravenous ketamine and midazolam for painful procedures in children.
abstract: BACKGROUND
  Children often require relief of pain and anxiety when undergoing painful procedures. The purpose of this study is to evaluate the effectiveness and safety of painful pediatric procedures performed by pediatric intensivist, using the combination of intravenous ketamine and midazolam for sedation and analgesia.
  
  
  METHODS
  The records of the patients who received intravenous ketamine-midazolam combination for painful procedures in the pediatric sedation unit of a university hospital over a 3 year period were retrospectively reviewed to determine indications, dosing, assessment of the level of sedation, adverse events, and recovery time for each procedural sedation and analgesia.
  
  
  RESULTS
  A total of 227 children aged 4 months to 18 years were admitted to the pediatric sedation unit for a total of 356 procedures. The indications for procedural sedation and analgesia included bone marrow aspiration or biopsy (50.8%), central venous catheter insertion (27%), and others (22%). A total of 46 adverse events (12.9%) were observed. These adverse events included SpO2 below 85% without apnea (n = 14), apnea (n = 3), transient stridor (n = 2), hypertension and tachycardia (n = 8), hypersalivation (n = 6), vomiting (n = 5), hallucinatory emergence reaction (n = 4), and rash (n = 4). There were no adverse outcomes attributable to ketamine and midazolam combination.
  
  
  CONCLUSIONS
  Skilled pediatric intensivists can safely and effectively administer ketamine and midazolam to facilitate painful procedures outside the operating room setting.
authors.affiliation: Pediatric Intensive Care Unit, Faculty of Medicine, Ege University, Izmir, Turkey. bkarapinar@hotmail.com
authors.forename: Bülent
authors.initials: B
authors.lastname: Karapinar
authors.forename: Deniz
authors.initials: D
authors.lastname: Yilmaz
authors.forename: Kubilay
authors.initials: K
authors.lastname: Demirağ
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kantar
mesh_terms: D000293:Adolescent; D000700:Analgesics; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D007649:Ketamine; D008297:Male; D008874:Midazolam; D010100:Oxygen / Q000097:blood; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam; D010100:Oxygen