Intravenous ketamine plus midazolam vs. intravenous ketamine for sedation in lumbar puncture: a randomized controlled trial.
OBJECTIVE
To compare a combined dose of ketamine and midazolam versus ketamine alone in the sedation of children requiring lumbar puncture.


METHODS
A randomized, controlled study, conducted between January 2004 and December 2006.


METHODS
The Pediatric Emergency Department (PED) at Ankara Training and Research Hospital, Turkey.


METHODS
A random sample of 99 children (59 boys, 40 girls) aged 2-14 years (mean age 6.5+/-3.7) undergoing lumbar puncture.


METHODS
Participants were randomized to receive intravenous (IV) ketamine only (1 mg/kg; IVK) (n=51) or ketamine plus midazolam (1 mg/kg ketamine+0.1 mg/kg midazolam; IVKM) (n=48).


METHODS
The mean time to sedation and adverse events.


RESULTS
The mean time to sedation was significantly shorter in the IVKM group than the IVK group (2.6+/-1.1 and 3.4+/-1.7 min, respectively; P=0.01). The parental satisfaction was significantly higher in the IVKM group (P=0.001). Also the fasting time and recovery time did not differ between groups, nor was there a significant difference in nausea/vomiting between groups. Nightmares or crying spells were more common in the IVK group than in the IVKM group (P=0.04).


CONCLUSIONS
We conclude that adding midazolam to ketamine did not increase the frequency of adverse events and that the combined sedative was superior to ketamine alone in terms of speed of sedation and parental satisfaction.
Dilli
Dilek
D
Department of Pediatrics, Ministry of Health, Ankara Training and Research Hospital, Turkey. dilekdilli2@yahoo.com
Dallar
Yildiz
Y
Sorgui
Nihan H
NH
D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D016001:Confidence Intervals; D004244:Dizziness / Q000139:chemically induced; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009325:Nausea / Q000139:chemically induced; D016017:Odds Ratio; D010101:Oxygen Consumption; D010146:Pain / Q000188:drug therapy*; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D014839:Vomiting / Q000139:chemically induced; D055815:Young Adult
D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D007649:Ketamine; D008874:Midazolam