Ketamine-based procedural sedation and analgesia for botulinum toxin A injections in children with cerebral palsy

Chow, Cristelle; Choong, Chew Thye

doi:10.1016/j.ejpn.2015.11.009

Cited by 13 publications

(18 citation statements)

References 22 publications

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“…However, many children with CP do not tolerate using a breathing mask, and there is a need for alternative methods. According to Chow et al and our results, midazolam in combination with ketamine might be a safe alternative.…”

Section: Discussionsupporting

confidence: 68%

“…In the first 24 hours after the treatment, one in five children experienced nausea, which is more than reported by Chow et al (5). There was a nonsignificant trend towards more nausea in the less motor impaired children.…”

Section: Discussionmentioning

confidence: 49%

“…A rectal combination of midazolam and racemic ketamine provided pain control for the vast majority of the children in our study. Accordingly, rectally administered drugs can be a better alternative than intravenously administered midazolam and racemic ketamine when children undergo injections with BoNT‐A , as no intravenous line is needed. The pain intensity, measured by the parents using the CAS scores and the healthcare professionals using the FLACC scores, was similar to the children's pain intensity in another study using 70% nitrous oxide and 30% oxygen .…”

Section: Discussionmentioning

confidence: 99%

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A rectally administered combination of midazolam and ketamine was easy, effective and feasible for procedural pain in children with cerebral palsy

et al. 2017

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

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A rectally administered combination of midazolam and ketamine was easy, effective and feasible for procedural pain in children with cerebral palsy

et al. 2017

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“…21,[37][38][39][40] Because several of these procedures are often performed in a day, and because patients are routinely discharged directly home after the intervention, it is important to have a regimen that allows for rapid onset of induction and rapid recovery from sedation. We attribute the speed of recovery and discharge in our study to (9,14) .06 Recovery time 13 (7,20) 10 (6,15) .09 Sedation total time 36 (32,41) 33 (26,40) .07…”

Section: Discussionmentioning

confidence: 99%

“…14 Chow and Choong used a ketamine-centered protocol with success in children with CP with an adverse event rate of 6.6%. 15 However, they reported that 2 hours of monitoring their patients after the procedure was required. The ideal sedative protocol in pediatric procedural sedation is one that is safe and effective and demonstrates rapid onset and rapid recovery 16 ; this ideal protocol remains elusive in this patient population.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of a Propofol and Ketamine Based Procedural Sedation Protocol in Children with Cerebral Palsy Undergoing Botulinum Toxin A Injections

Louer

McKinney

Abu‐Sultaneh

et al. 2019

PM&R

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Background: Pediatric patients with cerebral palsy often undergo intramuscular botulinum toxin (BoNT-A) injections. These injections can be painful and may require procedural sedation. An ideal sedation protocol has yet to be elucidated. Objective: To investigate the safety and efficacy of a propofol and ketamine based sedation protocol in pediatric patients with cerebral palsy requiring BoNT-A injections. Design: Retrospective chart review. Setting: The sedations took place in a procedural sedation suite at a tertiary children's hospital from February 2013 through September 2017. Patients: 164 patients with diagnoses of cerebral palsy undergoing propofol and ketamine based sedation for injections with botulinum toxin A. Methods: An initial bolus of 0.5 mg/kg ketamine followed by a 2 mg/kg bolus of propofol was administered with supplemental boluses of propofol as needed to achieve deep sedation during the intramuscular BoNT-A injections. Main Outcome Measurements: Propofol dosages, adverse events, serious adverse events, and sedation time parameters were reviewed. Results: 345 sedations were successfully performed on 164 patients. The median total dose of propofol was 4.7 mg/kg (interquartile range [IQR]: 3.5, 6.3). Adverse events were encountered in 10.1% of procedures including hypoxemia responsive to supplemental oxygen (9.6%) and transient apnea (1.4%). The mean procedure time, recovery time, and total sedation time were 10, 11 and 33 minutes, respectively. With regard to patient variables, including age, weight, dose of propofol, sedation time, and Gross Motor Function Classification System classification, there was no association with increased incidence of adverse events. Conclusion: Our sedation protocol of propofol and ketamine is safe and effective in children with cerebral palsy undergoing procedural sedation for intramuscular injections with BoNT-A. The adverse events encountered appeared to be related to airway and respiratory complications secondary to musculoskeletal deformities, emphasizing the importance of airway monitoring and management in these patients.

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Sedation and analgesia in children with cerebral palsy: a narrative review

et al. 2019

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Ketamine-based procedural sedation and analgesia for botulinum toxin A injections in children with cerebral palsy

Cited by 13 publications

References 22 publications

A rectally administered combination of midazolam and ketamine was easy, effective and feasible for procedural pain in children with cerebral palsy

A rectally administered combination of midazolam and ketamine was easy, effective and feasible for procedural pain in children with cerebral palsy

Safety and Efficacy of a Propofol and Ketamine Based Procedural Sedation Protocol in Children with Cerebral Palsy Undergoing Botulinum Toxin A Injections

Sedation and analgesia in children with cerebral palsy: a narrative review

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