Rectal Thiopental versus Intramuscular Ketamine in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial
نویسندگان
چکیده
INTRODUCTION Physicians frequently deal with procedures which require sedation of pediatric patients. Laceration repair is one of them. No study has been performed regarding the comparison between induction of sedation with sodium thiopental and ketamine in laceration repair. Therefore, the present study was aimed to comparison of induced sedation by rectal sodium thiopental and muscular injection of hydrochloride ketamine in pediatric patients need laceration repair. METHODS The presented study is a single-blinded clinical trial performed through 2013 to 2014 in Ayatollah Kashani and Alzahra Hospitals, Isfahan, Iran. Patients from 3 months to 14 years, needed sedation for laceration repair, were entered. Patients were sequentially evaluated and randomly categorized in two groups of hydrochloride ketamine with dose of 2-4 milligram per kilogram and sodium thiopental with dose of 25 milligram per kilogram. Demographic data and vital signs before drug administration and after induction of sedation, Ramsey score, time to onset of action, and sedation recovery time were evaluated. Chi-squared, Mann-Whitney, and Non-parametric analysis of covariance tests were used. P<0.05 was considered as a significant level. RESULTS In this study 60 pediatric patients were entered. 30 patients with mean age of 42.8±18.82 months were received sodium thiopental and the rest with mean age of 30.08±16.88 months given ketamine. Mann-Whitney test was showed that time to onset of action in sodium thiopental group (28.23±5.18 minutes) was significantly higher than ketamine (7.77±4.13 minutes), (p<0.001). The sedation recovery time in ketamine group (29.83±7.70) was higher than sodium thiopental. Depth of sedation had no significant difference between two groups based on Ramsey score (p=0.87). No significant difference was seen between two groups in the respiratory rate (df=1, 58; F=0.002; P=0.96) and heart rate (df=1, 58; F=0.98; P=0.33). However, arterial oxygen saturation level (df=1, 58; F=6.58; P=0.013) was significantly higher in ketamine group. CONCLUSION The findings of the present study show that Although the recovery time from sedation by ketamine is more than sodium thiopental, it's fast-acting function without effecting on the oxygen saturation level causes that ketamine is considered as the better choice for induction of sedation in pediatric patients need laceration repair. In addition, long-term effect of ketamine provides more time for the physician to do the procedure and this issue decreases the need probability to the repeated-dose. However, effectiveness of both drugs to decrease the agitation was equal, based on the Ramsey score.
منابع مشابه
Effect of Ondansetron on the Incidence of Ketamine Associated Vomiting in Procedural Sedation and Analgesia in Children: A Double-Blind, Randomized, Placebo-Controlled Trial
Background Vomiting is a common side effect of ketamine in children's sedation and there is still controversy about the use of an anti-emetic drug along with ketamine to reduce this complication. The aim of this study was to evaluate the effectiveness of ondansetron in controlling vomiting induced by intramuscular (IM), and intravenous (IV) ketamine for procedural sedation and analgesia in chil...
متن کاملOral Chloral Hydrate Compare with Rectal Thiopental in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial
INTRODUCTION The increasing use of diagnostic imaging in pediatric medicine has resulted in growing need for procedural sedation and analgesia (PSA) to minimize motion artifacts during procedures. The drug of choice in pediatric PSA was not introduced until now. The aim of the present study was comparison of oral chloral hydrate (OCH) and rectal sodium thiopental (RST) in pediatric PSA. METHO...
متن کاملEpisode 76 – Pediatric Procedural
http://www.annemergmed.com/article/S0196-0644(14)015790/abstract Luhmann JD, Schootman M, Luhmann SJ, Kennedy RM. A randomized comparison of nitrous oxide plus hematoma block versus ketamine plus midazolam for emergency department forearm fracture reduction in children. Pediatrics. 2006;118(4):e1078-86. Abstract Migita RT, Klein EJ, Garrison MM. Sedation and analgesia for pediatric fracture red...
متن کاملComparison of the Efficacy and Side Effects of Intravenous and Intramuscular Injection of Ketamine for Children Requiring Sedation: A Randomized Double-Blind Clinical Trial Study
Background Ketamine is an antagonist receptor of N-methyl-D-aspartate (NMDA), and phencyclidine derivate sedative agent. Thus the aim of this study was to evaluate the effect of intravenous (IV) and intramuscular (IM) injection of Ketamine for sedation procedure of children. Materials and Methods In this randomized clinical trial the patients, 1-6 year-old children referred to Emergency Departm...
متن کاملپیشدارو در بیهوشی اطفال: میدازولام در مقایسه با کتامین رکتال
Background: Premedication is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. The rectal route is one of the most commonly accepted means of drug administration. The aim of our study was to investigate and compare the efficacy of rectally administered midazolam versus that of ketamine as a premedication in pediatric patients.Methods: We performed a pro...
متن کامل