Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient

Shah, Shailesh; Shah, Sonia; Apuya, Jesus; Gopalakrishnan, Senthil; Martin, Timothy W.

doi:10.1007/s00540-008-0685-4

Cited by 41 publications

(23 citation statements)

References 13 publications

(14 reference statements)

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“…Fortuitously, ketamine has also been shown to be a valuable agent for procedural sedation in combative patients, mentally disabled patients or autistic patients. [25]…”

Section: Adverse Effects Of Sedative and Analgesic Agentsmentioning

confidence: 99%

Procedural sedation: A review of sedative agents, monitoring, and management of complications

2011

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Given the continued increase in the complexity of invasive and noninvasive procedures, healthcare practitioners are faced with a larger number of patients requiring procedural sedation. Effective sedation and analgesia during procedures not only provides relief of suffering, but also frequently facilitates the successful and timely completion of the procedure. However, any of the agents used for sedation and/or analgesia may result in adverse effects. These adverse effects most often affect upper airway patency, ventilatory function or the cardiovascular system. This manuscript reviews the pharmacology of the most commonly used agents for sedation and outlines their primary effects on respiratory and cardiovascular function. Suggested guidelines for the avoidance of adverse effects through appropriate pre-sedation evaluation, early identification of changes in respiratory and cardiovascular function, and their treatment are outlined.

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“…Fortuitously, ketamine has also been shown to be a valuable agent for procedural sedation in combative patients, mentally disabled patients or autistic patients. [25]…”

Section: Adverse Effects Of Sedative and Analgesic Agentsmentioning

confidence: 99%

Procedural sedation: A review of sedative agents, monitoring, and management of complications

2011

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“…They frequently require lateral thinking on the part of the anesthesiologists to make the induction process as smooth as possible. The main targets of these patients are rapid recovery, smooth postoperative pain, early discharge and low stress during the peroperative period [8]. …”

Section: Discussionmentioning

confidence: 99%

BIS-Guided Total Intravenous Anesthesia for Orchiopexy and Circumcision in a Child with Severe Autism: A Case Report

Okur

Arıkan

Temel

et al. 2012

Case Reports in Anesthesiology

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Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. We describe a case of 10-year-old male patient with severe autism undergoing orchidopexy and circumcision. Following premedication, anesthesia was induced with remifentanil, propofol, atracurium, and maintained with total intravenous anesthesia (propofol and remifentanil). The Bispectral Index System was monitored for determination of the depth of anesthesia. After surgery, all infusions were discontinued. The patient was then transferred to the postanesthetic care unit. There were no adverse events observed during the anesthetic management. The patient was discharged from the hospital on the second postoperative day. Bispectral Index System-guided Total Intravenous Anesthesia can provide some advantages for patient with autism, such as hemodynamic stability, early and easy recovery, to facilitate faster discharge, to optimize the delivery of anesthetic agents, to minimize its adverse effects, and to maximize its safety.

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“…Procedural sedation can be effected most easily with intramuscular or even oral ketamine given the low side effect profile and lack of need for intravenous access. It is controversial as to whether premedication with midazolam is needed to avoid emergency reactions from ketamine sedation, but the possibility should be discussed with the patient and care giver where appropriate 78 79…”

Section: Approach To the Evaluation Of The Patient With An Asdmentioning

confidence: 99%

Care of the patient with an autism spectrum disorder by the general physician

Venkat

Jauch

Russell

et al. 2012

Postgraduate Medical Journal

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Autism spectrum disorders (ASD), comprising classic autism, Asperger syndrome, Rett syndrome, childhood disintegrative disorder and pervasive development disorder-not otherwise specified, represent complex neurodevelopmental conditions characterised by impaired social interactions, difficulties with communication and repetitive, stereotyped behaviours. It is estimated that up to 1% of the general population may be affected by an ASD. Whether due to improved diagnostic techniques or a true rise in incidence, the prevalence of patients with ASD is rising, and these individuals are increasingly encountered in a variety of healthcare settings. Care givers of patients with an ASD report frequently that lack of awareness of the complications of these disorders and the method of appropriately assessing these individuals impair the effective delivery of healthcare to this patient population. It is now clear that patients with an ASD, in addition to the defining characteristics of these disorders, can present to the outpatient, emergency department and inpatient settings with a variety of psychiatric, neurological, gastrointestinal, nutritional/metabolic, dental, ophthalmological, cardiovascular, gynaecological, traumatic and musculoskeletal conditions that can require acute intervention. In addition, the common treatments given to patients with an ASD may result in side effects and complications that may require acute intervention. For physicians who encounter patients with an ASD, the combination of impaired social interactions, difficulties with communication and stereotyped behaviours creates an additional barrier to diagnosis and treatment of these individuals. Careful preparation of the examination environment, direct engagement of care givers and the patient and the use of communication techniques and pharmacological adjuncts can aid physicians in treating the patient with an ASD in the outpatient, emergency department and inpatient settings.

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Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient

Cited by 41 publications

References 13 publications

Procedural sedation: A review of sedative agents, monitoring, and management of complications

Procedural sedation: A review of sedative agents, monitoring, and management of complications

BIS-Guided Total Intravenous Anesthesia for Orchiopexy and Circumcision in a Child with Severe Autism: A Case Report

Care of the patient with an autism spectrum disorder by the general physician

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