AN ALTERNATIVE TO BRUTACAINE - A COMPARISON OF LOW-DOSE INTRAMUSCULARKETAMINE WITH INTRANASAL MIDAZOLAM IN CHILDREN BEFORE SUTURING

Objective-To compare the use of low dose intramuscular ketamine with h igh dose intranasal midazolam in children before suturing. Methods-Alt ogether 102 children with simple wounds between 1 and 7 years old were allocated to the two study groups. Results-Two children were excluded from the study because of deviation from the agreed protocol. The 50 children in the ketamine group were less likely to cry or need to be r estrained during the procedure than those in the midazolam group (p < 0.01).The median oxygen saturation was 97% in both groups. There was n o difference in the recovery behaviour and the range of time at which children were ready for discharge, although the median time for the la tter was shorter in the midazolam group (75 v 82 minutes). Vomiting oc curred in nine of the ketamine and four of the midazolam group. After discharge both groups had an unsteady gait (73% v 71%) which usually r esolved within two hours. Conclusion-Intranasal midazolam (0.5 mglkg) effectively sedated the children in that none could remember the sutur ing. However a significant number still had to be restrained (86% v 14 %). Intramuscular ketamine (2.5 mg/kg) produced dissociative anaesthes ia in the majority of cases and was the preferred drug of nurse, docto r, and parent.