as per the study below published from india, ketamine has more adverse
Anesth Essays Res. <https://www.ncbi.nlm.nih.gov/pubmed/26417129#> 2015
May-Aug;9(2):213-8. doi: 10.4103/0259-1162.154051.
A comparison of intranasal ketamine and intranasal midazolam for pediatric
1, Naphade RW
2, Nallamilli S
3, Mohd S
Author information <https://www.ncbi.nlm.nih.gov/pubmed/26417129#>
AIMS AND OBJECTIVES:
The aim of our study is to compare the efficacy and side-effects of
Midazolam administered nasally for the pediatric premedication.
MATERIALS AND METHODS:
We studied 100 American Society of Anesthesiology I and II children aged
from 1 to 10 years undergoing various surgical procedures. Totally, 50
children were evaluated for nasal ketamine (using 50 mg/ml vials) at the
dose of 5 mg/kg and the other 50 received nasal midazolam 0.2 mg/kg, before
induction in operation theater each patient was observed for onset of
sedation, degree of sedation, emotional status being recorded with a five
point sedation scale, response to venipuncture and acceptance of mask,
whether readily, with persuasion or refuse.
The two groups were homogenous. Midazolam showed a statistically
significant early onset of sedation (10.76 ± 2.0352 vs. 16.42 ± 2.0696
min). There were no significant differences in venipuncture score, sedation
scale at 20 min, acceptance of mask and oxygen saturation throughout the
study. Significant tachycardia and 'secretions were observed in the
intra operatively. Postoperatively emergence (8% vs. 0%) and secretions
(28% vs. 4%) were significant in the ketamine group. Nausea and vomiting
occurred in l6% versus 10% for midazolam and ketamine group.
Both midazolam and ketamine nasally are an effective pediatric premedication.
Midazolam has an early onset of sedation and is associated with fewer
Nasal; pediatric; premedication
On Sat, Aug 19, 2017 at 9:21 PM, Rick Place <[log in to unmask]> wrote:
> Thank you Daniel.
> This is an excellent summary and hits home with my experience almost to the
> And this is my sense of IN ketamine without the experience.
> Low dose is ineffective for decent sedation but might provide some pain
> relief. But does it do anything better than fentanyl.
> Ditto midazolam. Which I love. I am using it more and more. To calm
> agitated asthmatics who don't love the mask. For UA catheterizations on
> kids old enough to remember (e.g. 15 minutes). Lac repairs.
> And IN ketamine is full procedural sedation, regardless of the dose.
> So all of the headache with a variable, inconsistent result that could be
> achieved with other IN agents.
> It is perhaps a solution without a need?
> On Sat, Aug 19, 2017 at 6:23 PM, Tsze, Daniel S. <
> [log in to unmask]>
> > Hi Rick
> > We have a protocol for IN ketamine at our institution:
> > - 0.5-1 mg/kg, max dose 50 mg for analgesia
> > - 3-9 mg/kg, max dose 300 mg for procedural sedation
> > For analgesia, most of our providers still order IN fentanyl instead of
> > ketamine, mostly because we have found that the former works well and we
> > are very familiar with it, with little impetus to adopt the latter (so
> > far).
> > For procedural sedation, the large volume required when giving 9 mg/kg
> > with the concentration we have available (100 mg/mL) for some children is
> > one concern.
> > The other is that our protocol requires the same monitoring and staffing
> > (full monitors, sedation nurse, sedation MD) for IN ketamine as for IV
> > ketamine.
> > For kids who require procedural sedation/anxiolysis for lac repairs, we
> > have very good success with IN midazolam (which we are now also using
> > IN lidocaine to ameliorate the nasal burning), which does not require the
> > same monitoring as IV/IN ketamine, making IN midazolam preferable from a
> > resource/flow perspective in this context.
> > For kids who require procedural sedation for fracture reductions, our
> > group is very comfortable with IV ketamine, with some concern with the
> > ability to quickly re-dose or titrate up with IN ketamine if needed,
> > are some of the reasons we have not used IN ketamine for that indication.
> > Daniel Tsze
> > Director of Pain Management and Sedation Program
> > Division of Pediatric Emergency Medicine
> > NYP Morgan Stanley Children¹s Hospital
> > Assistant Professor of Pediatrics at CUMC
> > Department of Pediatrics
> > Columbia University College of Physicians and Surgeons
> > New York, NY
> > On 2017-08-17, 10:33 PM, "Pediatric Emergency Medicine Discussion List on
> > behalf of Rick Place" <[log in to unmask] on behalf of
> > [log in to unmask]> wrote:
> > >Is anyone using IN ketamine or does anyone have a protocol for this?
> > >
> > >There are plenty of other options, but every case is unique.
> > >
> > >I see literature from 1mg/kg to 9mg/kg. Seems like a crazy dosing range.
> > >
> > >Anyone with any direct experience with this?
> > >
> > >Rick Place
> > >
> > >Inova Fairfax
> > >
> > >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
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