''Lytic cocktail'' is the customary sedation before percutaneous renal
biopsy. Owing to deficient sedation and respiratory depression, this
approach is no longer advised. The intravenous combination of a benzod
iazepine plus ketamine, which has been found to be effective and safe
in several conditions, was therefore used for 60 pediatric biopsies. I
n addition to pulse oximetry, a physician trained in airway management
monitored the patient. The quality of sedation was acceptable (n = 7)
or optimal (n = 53) in all cases. None of the patients required venti
lation or intubation. A mild oxygen desaturation lasting 4 min or less
was detected in 6 patients. None of the patients experienced major ch
ange in respiratory rate or blood pressure. The administration of keta
mine and, in some cases, the biopsy puncture were associated with a mi
ldly increased heart rate. In conclusion, a benzodiazepine plus ketami
ne provides effective deep sedation for renal biopsy in childhood.