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Steve recently published a double blind placebo controlled randomized trial in Annals of ketamine IV
with and without versed that documented no benefit from versed.

R

Virgil Davis wrote:

> 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

--

Richard O. Gray MD. FAAEM
Assistant Professor Emergency Medicine
Hennepin County Medical Center
701 Park Avenue South
Minneapolis Minnesota 55405
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[log in to unmask]
"I can't complain but sometimes I still do."

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