Conscious Sedation: Off-Label Use of Rectal S(+)-Ketamine and Midazolam for Wound Dressing Changes in Paediatric Heat Injuries

“…Heinrich et al. (13) studied rectal S (+)‐ketamine and midazolam for wound dressing changes in pediatric burn injuries and reported that this combination allowed safe and painless dressing changes. Humphries et al.…”

Section: Discussionmentioning

confidence: 99%

Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes^a

Tosun¹,

Esmaoğlu²,

Çoruh

2007

Pediatric Anesthesia

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“…[3910] It is widely understood that pain is exacerbated by anxiety. In burns, the commonly used benzodiazepine is midazolam.…”

Section: Introductionmentioning

confidence: 99%

Comparison of effects of ketamine, ketamine-dexmedetomidine and ketamine-midazolam on dressing changes of burn patients

Gündüz

Sakalli

Güneş

et al. 2011

J Anaesthesiol Clin Pharmacol

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Objective:The aim of this randomized, controlled study was to compare the sedoanalgesic effects of ketamine-dexmedetomidine and ketamine-midazolam on dressing changes of burn patients.Materials and Methods:Following Ethics Committee approval and informed patient consent, 90 ASA physical statuses I and II adult burn patients were included in the study. Patients were randomly divided into three groups. Ten minutes before dressing change, the dexmedetomidine group (group KD) (n = 30) received a continuous infusion of dexmedetomidine at a rate of 1 μg kg-1, the midazolam group (group KM) (n = 30) received a continuous infusion of midazolam at a rate of 0.05 mg kg-1 and the saline group (group KS) (n = 30) received a continuous infusion of saline intravenously. One minute before dressing change, each patient was administered 1 mg kg-1 ketamine intravenously. Hemodynamic variables, pain and sedation scores, the number of patients requiring additional ketamine, time to dressing change and recovery time were recorded.Results:Systolic blood pressure (SBP) values were significantly lower at, before and after ketamine administration; and 5, 10 and 15 minutes after the procedure in group KD in comparison with the other groups (P <0.05). There was no significant difference in pain scores among the groups during the study period. Sedation scores were significantly higher in group KD than in groups KM and KS at the end of the first hour (P <0.05). Time to dressing change and recovery time were similar in all the groupsConclusion:In burn patients undergoing dressing changes, although both combinations ketamine-dexmedetomidine and ketamine-midazolam offered an effective sedoanalgesia without causing any significant side effect, the former resulted in higher sedation and lower hemodynamic discrepancy.

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“…B. Verbandswechsel bei kleinflächigen, leichten Verbrennungen, besteht die Mög-lichkeit der rektalen Gabe von S(+)-Ketamin (0,75 mg/kgKG) und Midazolam (0,4 mg/kgKG) [19]. Hierfür müssen allerdings die beschrieben Kontraindikationen respektiert und die genannten Richtlinien für die Durchführung eingehalten werden.…”

Section: Beispiele Für Analgosedierungen Bei Kindern Mit Esketamin (Kunclassified

Therapie akuter Schmerzen bei Kindern und Jugendlichen

Heinrich

Hoffmann

Zernikow

2010

Monatsschr Kinderheilkd

Self Cite

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Schmerzen gehören zu den häufigsten Ursachen für eine Konsultation des Kinderarztes. Die Stär-ke akuter Schmerzen kann anhand von Selbstbewertungs-oder Beobachtungsskalen erhoben werden. Akute Schmerzen jeder Genese müssen schnellstmöglich behandelt werden. Nach Ursachenerforschung und kausal ausgerichteter Therapie sind Ibuprofen und Paracetamol die am häufigsten eingesetzten Analgetika. Bei Letzterem sind das niedrige analgetische Potenzial sowie die geringe therapeutische Breite zu beachten. Bei starken bis sehr starken akuten Schmerzen sollten auch bei Kindern Opioide Mittel der ersten Wahl sein. Im Rahmen der postoperativen Schmerzbehandlung kommen Analgetikaregimes mit Basis-und Bedarfsanalgesie zum Einsatz. Starke Schmerzerfahrungen im Kindesalter können zur psychischen Traumatisierung führen und über die Ausbildung eines Schmerzgedächtnisses langfristig das Schmerzempfinden beeinflussen. Schmerzen müssen deshalb konsequent zu vermeiden versucht bzw. behandelt werden. AbstractPain is one of the most common causes for consultation of a paediatrician and represents a major problem in paediatrics. Simple self-reporting and behavioural pain scales are suitable for assessment of intensity of acute pain. Acute pain of whatever origin should be treated immediately. The most commonly used analgesics are ibuprofen and paracetamol (acetaminophen). In the case of paracetamol the narrow therapeutic range should be kept in mind. Opioids should be first choice in therapy of severe pain, also for children. Perioperative pain should be treated with a combination of non-pharmacological and pharmacological strategies with basis medication and medication on demand. Experience of severe pain can result in the generation of a chronic pain memory with emotional trauma which can have a long-term influence on the sensitivity to pain. Therefore, every effort should be made to prevent pain and to treat it effectively.

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Conscious Sedation: Off-Label Use of Rectal S(+)-Ketamine and Midazolam for Wound Dressing Changes in Paediatric Heat Injuries

Abstract: Conscious sedation with rectally applied S(+)-ketamine and Midazolam allows safe and painless dressing changes after heat injuries in children.

Cited by 23 publications

References 17 publications

Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes^a

Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes^a

Comparison of effects of ketamine, ketamine-dexmedetomidine and ketamine-midazolam on dressing changes of burn patients

Therapie akuter Schmerzen bei Kindern und Jugendlichen

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Conscious Sedation: Off-Label Use of Rectal S(+)-Ketamine and Midazolam for Wound Dressing Changes in Paediatric Heat Injuries

Abstract: Conscious sedation with rectally applied S(+)-ketamine and Midazolam allows safe and painless dressing changes after heat injuries in children.

Cited by 23 publications

References 17 publications

Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changesa

Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changesa

Comparison of effects of ketamine, ketamine-dexmedetomidine and ketamine-midazolam on dressing changes of burn patients

Therapie akuter Schmerzen bei Kindern und Jugendlichen

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Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes^a

Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes^a