Cm. Marx et al., KETAMINE-MIDAZOLAM VERSUS MEPERIDINE-MIDAZOLAM FOR PAINFUL PROCEDURESIN PEDIATRIC ONCOLOGY PATIENTS, Journal of clinical oncology, 15(1), 1997, pp. 94-102
Purpose: To compare the efficacy, characteristics of onset/recovery, a
nd safety of ketamine/atropine/midazolam with meperidine/midazolam use
d as premedication for painful procedures in children with cancer. Met
hods: A randomized, double-blind crossover trial for two successive pa
inful procedures (bone marrow aspiration or biopsy, lumbar puncture, o
r combined procedures) was performed at a referral-based pediatric hem
atology-oncology clinic and associated inpatient service of a universi
ty teaching hospital, Twenty-two children, aged 24 to 178 months, were
enrolled and 18 (81.8%) completed the double-blind, crossover trial,
Each child received intravenous premedication with either meperidine 2
mg/kg and midazolam 0.1 mg/kg (MM) or atropine 0.01 mg/kg, midazolam
0.05 mg/kg, and ketamine 1.5 mg/kg (KM) on one occasion followed by th
e alternative regimen on a second occasion, The initial premedication
regimen was chosen by random assignment. Results: Efficacy was assesse
d by a trained observer using the Observational Scale of Behavioral Di
stress-Revised (OSBD-R). Operator, nurse, parent, and patient opinions
of efficacy were recorded on a visual analog scale (VAS). Side effect
s were monitored by pulse oximetry, nasal end-tidal capnography, and s
erial blood pressure measurements. Use of KM resulted in significantly
less procedural distress than MM (1.37 +/- 2.20 v 7.04 +/- 8.06 OSBD-
R units; P <.05). Both operators and nurses rated KM more effective th
an MM. KM use was associated with earlier readiness for the procedure
(19.2 v 24.0 minutes) and more rapid recovery (39.3 v 74.6 minutes far
removal of monitoring devices and 58.5 v 87.1 minutes for discharge),
procedures undertaken after ketamine sedation were associated with fe
wer side effects than observed with MM sedation (hypoxia, 17.7% v 82.4
%: hypotension, 16.6% v 55.6%; reduced respiratory rate, 0% v 38.9%).
The incidence of emergence reactions or behavioral abnormalities withi
n 24 hours postprocedure was similar in both treatment groups. At 7 da
ys postprocedure, no child had persistent behavioral abnormalities and
all children had amnesia for the procedure, Parents and children expr
essed a preference for KM over MM in 12 of 18 cases (P <.05). Conclusi
on: A premedication regimen of KM produced superior sedation with a fa
ster onset and recovery and fewer side effects than a MM combination.
(C) 1997 by American Society of Clinical Oncology.