Cardiorespiratory Effects of Premedication for Children

Abstract

Cardiovascular and respiratory effects of pediatric preanesthetic premedication have received only minimal attention, probably because most children tolerate such drugs without apparent ill effect. In children with congenital heart disease or other serious illness, there is often reluctance to use premedication. We sought to determine whether different premedication regimens produced significant cardiorespiratory effect. A randomized prospective study of the cardiovascular and respiratory effects of different oral, nasal, and rectal premedication regimens was conducted. Fifty-eight young children (average age 2.7 yr) were studied. Oral meperidine (3 mg/kg) with pentobarbital (4 mg/kg) decreased heart rate, mean arterial pressure, cardiac index, respiratory rate, and oxygen saturation. Stroke volume was maintained. Nasal ketamine (5 mg/kg) with midazolam (0.2 mg/kg) produced no significant cardiovascular or respiratory effects. Rectal methohexital (30 mg/kg) increased heart rate with a coincident decrease in stroke volume but had no other positive or negative cardiac or respiratory effect. This information documents disparate cardiorespiratory effects of different preanesthetic medications in normal children.

Premedication with nasal s-ketamine and midazolam provides good conditions for induction of anesthesia in preschool children

“…Our study supports the data presented by Audenaert and colleagues 13 who found that the combination of intranasally administered racemic ketamine 5 mg·kg -1 and midazolam 0.2 mg·kg -1 did not produce significant cardiovascular and respiratory side effects. Taking into account that racemic ketamine has approximately half the potency of s-ketamine, 14 this dosage is comparable to our group K2.…”

“…Thus, we can only state that, based on this limited study, no serious complications were encountered. This and previously published studies on nasal ketamine and midazolam in children [8][9][10]13,18 without any reports of serious complications are no formal safety proof. One theoretical serious complication would be the penetration of s-ketamine and midazolam through the cribriform plate, giving rise to high central nervous system levels.…”

Rektale Pr�medikation von Kindern

“…Sie wird übereinstimmend als sicheres und effektives Verfahren angesehen, die kardiovaskulären Wirkungen als unbedeutend beschrieben: Herzminutenvolumen und Blutdruck bleiben gleich bei steigender Herzfrequenz und fallendem Schlagvolumen [3]. Wegen der v. a. bei Säuglingen nicht selten auftretenden Atemdepressionen sollte Methohexital nur von Ärzten verabreicht werden, die Erfahrung in der Sicherung des Atemwegs haben [27].…”

“…Audenaert et al [3] beobachteten keine Depression von Hämodynamik oder Atemantrieb (Ketamin 5 mg/kg plus Midazolam 0,2 mg/kg, nasal gegeben).…”

Anästhesie in der pädiatrischen Kardiologie

“…und Applikationsformen (nasal, rektal, i.m., s.c.) sind in der Literatur zu finden, ohne dass sich aufgrund der Datenlage die Bevorzugung eines Regimes eindeutig rechtfertigen ließe. [10].…”