Abstract

CLARO, María C et al. Sedación y analgesia en los procedimientos diagnósticos y terapéuticos en el paciente pediátrico. Arch. argent. pediatr. [online]. 2006, vol.104, n.6, pp.512-519. ISSN 0325-0075.

Introduction. Keeping children's acute pain and fear under control favours a comprehensive care and a better quality of life. Objective. To share our pediatric working experience based on the use of midazolam and ketamine association in the management of acute pain during brief pediatric procedures. Population, material and methods. 75 patients (aged 6 months to 15 years old) were treated between June 1999 and June 2002. Patients with contraindication for the use of ketamine low tolerance, without due fastening o hemodinamically imbalanced were excluded. Level o sedation, pain relief, side effects and wakening syndrome were evaluated. Heart rate, respiratory rate, oxigen saturation and blood pressure were recorded every 5 minutes. Midazolam 0.1 mg/kg and ketamine 1 mg/kg were used intravenous. Results. 150 procedures were carried out in 75 patients: Lumbar puncture: 65; bone marrow puncture and/or biopsy: 36; bone marrow puncture and lumbar puncture: 26; pleural puncture (PP) and/or thoracotomy tube: 13, and reductions of fractures: 10. A suitable level of sedation and pain relief was achieved in 80%, recovering took less than 30 minutes in 80% of the cases. A decrease in oxygen saturation below 85% was seen in only 2%, and was corrected with oxygen supply. There was 1 patient with respiratory distress, 1 with visual hallucinations which reverted with emotional support and 2 patients experienced sialorrhea. Conclusion. In our experience, the association of midazolam and ketamine was safe and effective for analgesia and sedation in painful procedures performed at the bed-side of pediatric patients.

Keywords : Ketamine; Midazolam; Sedation; Analgesia; Procedures.

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