KETAMINE-MIDAZOLAM VERSUS MEPERIDINE-MIDAZOLAM FOR PAINFUL PROCEDURESIN PEDIATRIC ONCOLOGY PATIENTS

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.