Oral ketamine/midazolam is superior to intramuscular meperidine, promethazine, and chlorpromazine for pediatric cardiac catheterization

An IM combination of meperidine, promethazine, and chlorpromazine (DPT) has been given as sedation for pediatric procedures for more than 40 years. We compared this WI combination to oral (PO) ketamine/midazolam in children h aving cardiac catheterization. A total of 51 children, ages 9 mo to 10 yr, were enrolled and randomized in this double-blinded study. All children rec eived an IM injection at time zero and PO fluid 15 minutes later. We observ ed acceptance of medication, onset of sedation and sleep, and sedative effi cacy. The cardiorespiratory changes were evaluated. Sedation was supplement ed with IV propofol as required. Recovery time parental satisfaction, and p atient amnesia were assessed. Ketamine/midazolam given PO was better tolera ted (P < 0.0005), had more rapid onset (P < 0.001), and provided superior s edation (P < 0.005). Respiratory rate decreased after IM DPT only. Heart ra te and shortening fraction were stable. Oxygen saturation and mean blood pr essure decreased minimally in both groups. Supplemental propofol was more f requently required (P less than or equal to 0.02) and in larger doses (P < 0.05) after IM DPT. Parental satisfaction ratings were higher (P < 0.005) a nd amnesia was more reliably obtained (P = 0.007) with PO ketamine/midazola m. Two patients needed airway support after the PO medication, as did two o ther patients when PO ketamine/midazolam was supplemented with IV propofol. Although PO ketamine/midazolam provided superior sedation and amnesia comp ared to IM DPT, this regimen may require the supervision of an anesthesiolo gist for safe use. Implications: Oral medication can be superior to IM inje ctions for sedating children with congenital heart disease; however, the sa fety of all medications remains an issue.