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- Novak, Helene, et al.
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Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children
- 2008
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In: Paediatric Anaesthesia. - : Wiley. - 1460-9592. ; 18:1, s. 48-54
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Journal article (peer-reviewed)abstract
- Background: Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire-guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low-dose midazolam in young children undergoing these procedures before and also after discharge from the hospital. Methods: A total of 244 biopsy procedures in 217 children under the age of 16 years were evaluated. All anesthesia records were reviewed according to a defined study protocol and in 145 cases the parents were also interviewed by telephone to obtain further information on possible adverse effects before and after discharge. Results: Ketamine and low-dose midazolam were carefully titrated by an experienced anesthesia team at an approximate dose ratio of 40 : 1 (total doses 2.3 and 0.05 mg·kg−1) in continuously monitored spontaneously breathing children. Possibly associated problems before discharge were salivation (5.7%), vomiting (4.9%), oxygen desaturation (3.3%), laryngospasm (2.5%) and rash (1.2%) according to the patient records and blurred vision (27%), nausea and vomiting (19%), vertigo (13%) and hallucinations or nightmares (3.5%) according to telephone interviews. Few, mild and transient problems remained after discharge from the hospital. Conclusions: Careful titration of ketamine and low-dose midazolam provides adequate sedation for nonsurgical pediatric short-term procedures also requiring considerable pharyngeal manipulation, particularly considering the low number of serious airway problems such as laryngospasm. The high incidence of late postoperative problems suggests that prospective studies should be designed for long-term follow-up of young children subjected to sedation or anesthesia.
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- Li, Yuhong, et al.
(author)
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Plasma and renal clearances of lactated Ringer's solution in pediatric and adult patients just before anesthesia is induced
- 2009
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In: Pediatric Anaesthesia. - : Wiley-Blackwell. - 1155-5645 .- 1460-9592. ; 19:7, s. 682-687
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Journal article (peer-reviewed)abstract
- BACKGROUND: Lactated Ringer's solution is most widely used in children, but little is known about how children who are scheduled for surgery handle a fluid load when compared to adults. This study explores whether a more cautious regimen for the administration of lactated Ringer's is warranted in children awaiting minor surgery when compared to adults.METHODS: Plasma dilution (based on hemoglobin), urinary excretion, and volume kinetics were used to assess the disposition of an i.v. infusion of 10 ml x kg(-1) of lactated Ringer's solution over 20 min in 14 pediatric patients (4 years of age, average body weight 15 kg) and in 14 adult patients scheduled for similar minor pelvic surgery. Experiments were performed after premedication, but before anesthesia was induced.RESULTS: Plasma dilution was less pronounced in the pediatric patients (P < 0.03) who also had excreted more of the infused fluid within 90 min than the adults (43% vs 18%, P < 0.03). After correction for body weight, their plasma clearance was 4 times higher (P < 0.02) and the renal clearance of lactated Ringer's solution 7 times higher (P < 0.001) than those of the adults. The more rapid turnover of fluid in the children might be explained by a shorter period of preoperative fasting (6 vs 10 h) and/or by physiological differences attributable to age.CONCLUSION: The plasma and renal clearances of lactated Ringer's solution were higher in children with a body weight of about 15 kg in comparison with adults. Therefore, children in this age group may receive at least the same amounts of fluid per kilo body weight during preparation for surgery as the amounts recommended for adults.
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