Oral Ketamine/Midazolam Is Superior to Intramuscular Meperidine, Promethazine, and Chlorpromazine for Pediatric Cardiac Catheterization

Auden, Steve M.; Sobczyk, Walter L.; Solinger, Robert E.; Goldsmith, L. Jane

doi:10.1213/00000539-200002000-00011

Cited by 39 publications

(7 citation statements)

References 28 publications

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“…In our opinion, the observed electrocardiographical changes due to promethazine administration should lead to the avoidance of this drug in premedication administered to patients before electrophysiological diagnostics and procedures as it may influence the results. Nonetheless, such a method has been used by several authors who did not discuss this problem [26, 27].…”

Section: Discussionmentioning

confidence: 99%

Influence of promethazine on cardiac repolarisation: a double‐blind, midazolam‐controlled study

Owczuk¹,

Twardowski²,

Dylczyk-Sommer³

et al. 2009

Anaesthesia

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Drugs used in anaesthesia may provoke torsadogenic changes in cardiac repolarisation. The aim of this study was to assess the effect of promethazine on the parameters of ventricular repolarisation: QTc interval and transmural dispersion of repolarisation. Forty patients were randomly allocated to receive promethazine (25 mg) or midazolam (2.5 mg). Changes in the ECG and arterial blood pressure were recorded. Correction of QT interval was calculated using Bazett's formula and Fridericia's correction; transmural dispersion of repolarisation was determined as T(peak)-T(end) time. Significant prolongation of QT interval, corrected with both formulae, was detected in patients receiving promethazine, while no change in the QTc value was observed in the midazolam group. There were no significant differences in T(peak)-T(end) time either between or within the groups. In conclusion, promethazine induces significant QTc prolongation but the lack of influence on transmural dispersion of repolarisation makes the risk of its torsadogenic action very low.

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Section: Discussionmentioning

confidence: 99%

Influence of promethazine on cardiac repolarisation: a double‐blind, midazolam‐controlled study

Owczuk¹,

Twardowski²,

Dylczyk-Sommer³

et al. 2009

Anaesthesia

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“…A comprehensive review of such strategies may be found elsewhere, [12][13][14] but generally include the use of light or deep sedation, local anesthesia, and cognitivebehavioral techniques. 18,19 Cognitive-behavioral techniques include hypnosis, 20,21 deep breathing, 22,23 positive suggestion and distraction, 24 and modeling. 18,19 Cognitive-behavioral techniques include hypnosis, 20,21 deep breathing, 22,23 positive suggestion and distraction, 24 and modeling.…”

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confidence: 99%

Procedural Distress in Children With Cancer

Walco

Conte

Labay

et al. 2005

The Clinical Journal of Pain

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Self-report measures, behavioral indicators, and physiological changes are not interchangeable outcomes. Treatment strategies were effective for minimizing subjective and behavioral distress, but not necessarily for physiological reactions. Future research should focus on individual differences in these responses, and treatment outcome studies aimed at reducing distress must be clear about the specific goals of intervention.

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“…Oral midazolam, which was not available to us at the time of the study, has been found to have better effect than diazepam when taken in combination with oral ketamine. 10,11 The incidence of hypersalivation in adult patients receiving 4-10 mg/kg was 17.5-32.5%. The study of Gutstein et al 12 on oral ketamine in paediatric patients, in which 3-6 mg/kg was used, showed that increased salivation occurred in 13-33% of cases.…”

Section: Resultsmentioning

confidence: 99%

Oral ketamine for wound care procedures in adult patients with burns

Ezike

Odiakosa²

2011

Southern African Journal of Anaesthesia and Analgesia

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Background: This prospective study was carried out to evaluate the usefulness of oral ketamine for burn wound dressing in adult patients. The aim was to achieve a state-of-conscious sedation in which the patient would be communicative and cooperative, with minimal, or no pain during burn wound care procedures. Method: Two hundred and forty wound care procedures were randomly assigned to six treatment groups of patients (groups A-F). The quantities of oral ketamine that they received were as follows: Group A, 0.5 mg/kg; B, 2 mg/kg; C, 4 mg/kg; D, 6 mg/kg; E, 8 mg/kg and F, 10 mg/kg. A five-point verbal rating scale was used to assess pain intensity: the AVPU (alert, voice, pain, unresponsive) scale for level of consciousness. The Likert scale was used for patient satisfaction. Blood pressure, pulse rate and oxygen saturation were monitored. Adverse effects were noted. Comparisons of the efficacy and safety of the different dosages of oral ketamine were made using the SPSS package. The efficacy criterion was verbal rating scale (VRS) ≤ 2, i.e no pain, mild pain or discomfort. Results: Patients in groups A and B reported higher levels of pain, and in groups C, D, E and F, there were varying degrees of efficacy. Groups E and F had the best analgesic profiles, but at the higher doses, some patients became anaesthetised. The most common adverse effects reported were hallucination (37%) and hypersalivation (29.9%), which occurred more frequently in groups E and F. The patients' assessments of pain were best in Group D, and worst in Group A. Conclusion: The minimum effective subanaesthetic dose of oral ketamine for analgesia during wound care procedures in adult patients with burns was 6 mg/kg.

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Oral Ketamine/Midazolam Is Superior to Intramuscular Meperidine, Promethazine, and Chlorpromazine for Pediatric Cardiac Catheterization

Cited by 39 publications

References 28 publications

Influence of promethazine on cardiac repolarisation: a double‐blind, midazolam‐controlled study

Influence of promethazine on cardiac repolarisation: a double‐blind, midazolam‐controlled study

Procedural Distress in Children With Cancer

Oral ketamine for wound care procedures in adult patients with burns

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