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I can't wait for Steve Green to respond, but...

If you use 4mg/kg IM then you really don't need to titrate - I've yet to see this fail.

The pain of the IV is probably less of an issue than the anxiety it produces among both parent and
child and the nursing time it takes.  An IM shot is fast and over before the child knows it, not so
with the IV attempt(s),

Two good studies show that Versed is really unecessary to prevent emergence reactions, so many
people no longer administer that.

Virgil Davis


Nikolaus wrote:

> Dear Dr. Rodriguez,
>
> just to give more power to your statistics:
> I usually add low dose midazolam at any age, but cannot really comment
> on whether it makes a real difference at any age; I also add atropine.
> Concerning the i.m.-dosing I'm not surprised, that you get mixed
> results. Since the i.m.-injection is not clearly less painful than
> placing an i/v.-line, I very rarely see a reason to give ketamine i.m.;
> you totally miss the luxury to be able to titrate, which you have with
> the i.v.-way.
>
> Greetings,
>
> Dr. Nikolaus Lutz-Dettinger
> PICU
> University Hospital Gent
> De Pintelaan 185
> B9000 Gent
> Belgium
> tel: **32 - 9 - 240 21 11
> fax: **32 - 9 - 240 49 95
> email: [log in to unmask]
>
> Elliot Rodriguez wrote:
> >
> > I don't know if this has alreay been brought up on the list but I was
> > wondering what the group's practice habit is regarding the addition of
> > Versed to IM/IV ketamine to reduce the incidence of dysphoric emergence
> > reactions.  I always add atropine or glyccopyrolate but don't always add
> > Versed as some sources I've read recommend - I do use it when sedating
> > older kids due to the higher risk of dysphoria.
> > Also I recently had a unusual failure of ketamine (admittedly I slightly
> > underdosed using only 3mg/kg IM) and wasn't able to find a reference as
> > to the safety of multiple doses (more than two)of ketamine for the same
> > procedure or what the maximum mg/kg dose is.
> >
> > Elliot Rodriguez, MD FACEP
> > SUNY HSC Syracuse
> >
> > 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://www.brown.edu/Administration/Emergency_Medicine/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://www.brown.edu/Administration/Emergency_Medicine/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://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html