The last review on Ketamine that I saw said to think about ketamine as a switch that is either in the on or off position, thus, enough ketamine needs to be given (with the expert concensus being 1.5mg/kg) to cross the threshold and induce anesthesia. Also, giving larger doses with induction does not keep the pt under longer, rather, one must re-dose the ketamine as the pt emerges. I do not believe that using a local anesthetic would have anything to do with lowering the threshold dose for ketamine to induce anestheasia or allow them to wake up faster. It may benefit the pt when they wake up, though!
James Reingold, M.D.
Banner Desert Children's Hospital
Mesa, AZ> Date: Wed, 14 Jan 2009 12:07:04 -0800> From: [log in to unmask]> Subject: Re: Tongue lacerations> To: [log in to unmask]> > I agree with Marty. If it crosses the edge (the origin of "speaks with forked tongue" has nothing to do with Adam and Eve) I do it. I also sew up big lacs (>50% of width), even if it doesn't cross the edge. I also use ketamine (without Versed but let's not go there), even though I have seen oral lesions listed as a relative contraindication for ketamine, due to increased oral secretions. I've never let that stop me and haven't been burned in lots and lots of ketamine, but would love to hear the list's opinion on that one. I use some lidocaine - decreases pain and decreases total dose of ketamine and so length of sedation. Last, I use Vicryl, because it lays flat and is less irritating when the kid wakes up, and I always close in at least two layers, in case the kid chews through the top layer. I've never sent anyone to the OR, and really haven't involved OMF/ENT with these.> > PS: I have no idea about the "forked tongue" thing but thought it was interesting and decided to put it out there and see who bites in a vitriolic response.> > Neil Mullen, MD FACEP, FAAP> Madigan Army Medical Center, Tacoma, WA> St. Peter's Hospital, Olympia, WA> > --- On Tue, 1/13/09, Martin Herman, M.D. <[log in to unmask]> wrote:> > From: Martin Herman, M.D. <[log in to unmask]>> Subject: Re: Tongue lacerations> To: [log in to unmask]> Date: Tuesday, January 13, 2009, 10:56 PM> > FOr the most part we are not suturing tongue laceration unless they have> caused the tongue to appear to be bifurcated by crossing the edge or have a> flap type lesion . If the lac is central, we let it heal on it's own.> IF we do suture , I sedate with ketamine and versed.> > Marty> > > On Tue, Jan 13, 2009 at 10:35 AM, William Krief <[log in to unmask]> wrote:> > > The approach to procedural sedation of a young child with a significant> > tongue> > laceration varies within our department. I was looking for the Lists'> > feedback> > on 1) which sedatives, analgesics, and adjuncts are being used for the> > repair> > of tongue lacerations; 2) how deeply are you sedating these patients; 3)> > which cases are you sending to the OR.> >> > Thank you,> >> > William Krief> > Division of Pediatric Emergency Medicine> > Schneider Children's Hospital> >> > For more information, send mail to [log in to unmask] with the> > message: info PED-EM-L> > The URL for the PED-EM-L Web Page is:> > http://listserv.brown.edu/ped-em-l.html> >> > > > -- > Marty> Martin Herman, M.D.> Pediatric Emergency Specialists, P.C.> Lebonheur Children's Medical Center> Memphis Tn 38103> > 901 287 5986 ( ED office)> 901 287 6226 ( ED fax)> > For more information, send mail to [log in to unmask] with the> message: info PED-EM-L> The URL for the PED-EM-L Web Page is:> http://listserv.brown.edu/ped-em-l.html> > > > > > For more information, send mail to [log in to unmask] with the message: info PED-EM-L> The URL for the PED-EM-L Web Page is:> http://listserv.brown.edu/ped-em-l.html
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