title: Procedural sedation for insertion of central venous catheters in children: comparison of midazolam/fentanyl with midazolam/ketamine.
abstract: BACKGROUND
  There is a lack of studies evaluating procedural sedation for insertion of central venous catheters (CVC) in pediatric patients in emergency departments or pediatric intensive care units (PICU). This study was designed to evaluate whether there is a difference in the total sedation time for CVC insertion in nonintubated children receiving two sedation regimens.
  
  
  METHODS
  Patients were prospectively randomized to receive either midazolam/fentanyl (M/F) or midazolam/ketamine (M/K) i.v. The Children's Hospital of Wiscosin Sedation Scale was used to score the sedation level.
  
  
  RESULTS
  Fifty seven patients were studied (28 M/F and 29 M/K). Group M/F received midazolam (0.24 +/- 0.11 mg.kg(-1)) and fentanyl (1.68 +/- 0.83 microg.kg(-1)) and group M/K received midazolam (0.26 +/- 0.09 mg.kg(-1)) and ketamine (1.40 +/- 0.72 mg.kg(-1)). The groups were similar in age, weight, risk classification time and sedation level. Median total sedation times for M/F and M/K were 97 vs 105 min, respectively (P = 0.67). Minor complications occurred in 3.5% (M/F) vs 20.7% (M/K) (P = 0.03). M/F promoted a greater reduction in respiratory rate (P = 0.005).
  
  
  CONCLUSIONS
  In this study of nonventilated children in PICU undergoing central line placement, M/F and M/K provided a clinically comparable total sedation time. However, the M/K sedation regimen was associated with a higher rate of minor complications. A longer period of study is required to assess the efficacy and safety of these sedative agents for PICU procedures in nonintubated children.
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil. psls.nat@terra.com.br
authors.forename: Paulo Sérgio
authors.initials: PS
authors.lastname: Lucas da Silva
authors.forename: Simone Brasil
authors.initials: SB
authors.lastname: Oliveira Iglesias
authors.forename: Flávia Vanesca Félix
authors.initials: FV
authors.lastname: Leão
authors.forename: Vânia Euzébio
authors.initials: VE
authors.lastname: Aguiar
authors.forename: Werther
authors.initials: W
authors.lastname: Brunow de Carvalho
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000700:Analgesics; D018686:Anesthetics, Intravenous; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl