Title: Evaluation of Safety Profile of Procedural Sedation and Analgesia using a combination of Intravenous Ketamine and Midazolam in the Paediatric Intensive Care Unit
Authors: Abhijeet Trivedi, Neil Castellino
DOI: https://dx.doi.org/10.18535/jmscr/v10i9.06
Abstract
Background: Procedural sedation and analgesia (PSA) is a method of administering sedatives, analgesics and dissociative agents for sedation, anxiolysis and motor control for painful diagnostic and therapeutic procedures among the children. Various sedative or dissociative agents are employed during but they are associated with adverse events. In this backdrop, the present study was done to evaluate the safety profile of Ketamine and Midazolam as PSA agents in children.
Materials and Methods: This was a prospective and retrospective hospital based observational study conducted among the 294 children subjected to PSA for various diagnostic and therapeutic procedures. The primary outcome measure was any change in the hemodynamic variables during the PSA procedure. The secondary outcome was to identify the risk factors associated with adverse events during PSA.
Results: In this study the main indication for PSA was diagnostic in 65.3% of children. The overall success rate of PSA procedure was 99.5%.There were totally 56 primary outcome and the major outcome was change in blood pressure (>20%) in 6.5% of the patient. In primary outcome, two cases of laryngospasm and 1 case of convulsion were reported as serious adverse event. Regarding secondary outcome, dose of ketamine and midazolam and ASA status showed no significant association with adverse event. Meanwhile, children with age < 6months were significantly associated with adverse event (p=0.04).
Conclusion: The combination of ketamine and midazolam was found to be safer with high success rate in children undergoing PSA.
Keywords: Procedural sedation and analgesia, children, ketamine, midazolam, adverse events.
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