We have not been happy with oral midazolam either -- too unpredictable in
time of onset and depth and duration of effect.
We have been using Nitronox with some mixed results, primarily depending
on age and development. We have had some excellent sedation in older
children (over about age 7) and adolescents who have been able to
understand our pre-sedation instructions, particularly the one about
having to breathe deeper to get more sedation. Typically, the younger
children remove the mask as soon as they experience any discomfort, and
we're back to square 1. I have particularly noted that the typical radius
ulna reduction is difficult to do with Nitronox, since we usually don't
get very good pre-reduction muscle relaxation. For multiple or difficult
lacerations, though, we've had some great results.
I will be interested to see others' experience with ketamine. We haven't
used it here, but think about it frequently.
Allen R. Walker, M.D.
Pediatric Emergency Medicine
On Mon, 6 Feb 1995, Jeffrey F Linzer wrote:
> Does anyone have any experience with low dose IM ketamine? We have
> been using 1-1.5 mg/kg with a great deal of success; the child is usually
> well sedated in 5-10 minutes. The sedation lasts about 30 minutes and the
> children are up and drinking in less than an hour.
> Our experience with oral Versed has not been rewarding. Has anyone been
> using Nitronox?
> Jeff Linzer, MD, MICP
> Division of Pediatric Emergency Medicine
> Egleston Children's Hospital at Emory University &
> Hughes Spalding Children's Hospital
> Atlanta, Georgia
> (404) 315-2747
> (404) 325-6233 (fax)
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