A little late on replying to this message, but I will weigh in with the
opinion that children receiving the doses mentioned ought to be monitored
with at least continous pulse oximetry until they have recovered. We
recently prepared for JCAHO with a hospital-wide sedation meeting. There
were enough anecdotes about problems with chloral hydrate over 40-50
mg/kg that I became a believer, even tho it means a lot more work for the
PED staff, particularly for neuro-imaging.
On Sun, 29 Jan 1995, Thomas Terndrup wrote:
> On January 27, Daniel Joyce wrote:
> "Our most recent
> conscious sedation policy mandates IV sedation/analgesia, even in kids. Now
> that there is emla, and considering the variable response to other routes,
> I grudgingly agree. Now let's talk about ketamine....."
> Could you describe the rationale for why i.v. sedation/analgesia is mandated
> by your new conscious sedation policy? Our experience in Syracuse is that
> we are able to use oral or rectal administration for sedation and analgesia
> for the majority of indications in younger children. While we would not
> hesitate to obtain vascular access in someone with a both bones forearm
> fracture, we would generally use an oral administration for the uncoopera-
> tive toddler with a forehead laceration.
> Does anyone think that oral midazolam or chloral hydrate at doses of
> between 0.5 to 1.0 mg/kg and 70 to 80 mg/kg requires continuous pulse
> oximetry for routine monitoring in ASA class I or II children in the ED?
> Tom Terndrup, MD