Efficacy and safety of low dose oral ketamine for controlling pain and distress during intravenous cannulation in children: a double-blind, randomized, placebo-controlled trial
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Ketamine is widely used in infants and young children for procedural sedation and anesthesia. The aim of this study was to evaluate the efficacy and safety of low dose oral ketamine to control pain and distress in children during intravenous (IV) cannulation. Methods: This is a prospective, randomized, double-blind study, including children aged between 3 and 6 years requiring a non-emergent IV-line placement. Children were randomly assigned to two groups, treated either with oral ketamine or a placebo. All patients were monitored for vital signs. Pain was assessed using the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wong-Baker Faces Pain Rating Scale (WBFS) scales and sedation using a 5-point sedation score. The facility of IV-line placement was measured by a 3-point scale. Adverse effects were recorded after 1 and 24 hours. Results: A total of 79 and 81 children were entered in the ketamine and placebo groups, respectively. The heart and respiratory rates increased significantly in the placebo group. The median CHEOPS 4 (95% confidence interval [CI]: 3, 4, P < 0.001) and WBFS 6 (95% CI: 4, 6, P < 0.001) scores decreased statistically in the ketamine group. IV-line placement was 50% easier in the ketamine group (95% CI: 37%, 63%, P < 0.001). No serious adverse effects were observed in all cases. Conclusions: Low dose oral ketamine effectively decreased the pain and distress during IV cannulation in children without any significant adverse reactions.
Abstract
Background: Ketamine is widely used in infants and young children for procedural sedation and anesthesia. The aim of this study was to evaluate the efficacy and safety of low dose oral ketamine to control pain and distress in children during intravenous (IV) cannulation. Methods: This is a prospective, randomized, double-blind study, including children aged between 3 and 6 years requiring a non-emergent IV-line placement. Children were randomly assigned to two groups, treated either with oral ketamine or a placebo. All patients were monitored for vital signs. Pain was assessed using the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wong-Baker Faces Pain Rating Scale (WBFS) scales and sedation using a 5-point sedation score. The facility of IV-line placement was measured by a 3-point scale. Adverse effects were recorded after 1 and 24 hours. Results: A total of 79 and 81 children were entered in the ketamine and placebo groups, respectively. The heart and respiratory rates increased significantly in the placebo group. The median CHEOPS 4 (95% confidence interval [CI]: 3, 4, P < 0.001) and WBFS 6 (95% CI: 4, 6, P < 0.001) scores decreased statistically in the ketamine group. IV-line placement was 50% easier in the ketamine group (95% CI: 37%, 63%, P < 0.001). No serious adverse effects were observed in all cases. Conclusions: Low dose oral ketamine effectively decreased the pain and distress during IV cannulation in children without any significant adverse reactions.
참고문헌 (47)
- Blount RL, "Pediatric procedural pain", Behav Modif, 30, pp.24~49 (2006)
- Krauss B, "Procedural sedation and analgesia in children", Lancet, 367, pp.766~780 (2006)
- Fradet C, "A prospective survey of reactions to blood tests by children and adolescents", Pain, 40, pp.53~60 (1990)
- Green SM, "Clinical practice guideline for emergency department ketamine dissociative sedation in children", Ann Emerg Med, 44, pp.460~471 (2004)
- Green SM, "Intravenous ketamine for pediatric sedation in the emergency department : safety profile with 156 cases", Acad Emerg Med, 5, pp.971~976 (1998)
- Green SM, "Intramuscular ketamine for pediatric sedation in the emergency department : safety profile in 1, 022 cases", Ann Emerg Med, 31, pp.688~697 (1998)
- Sherwin TS, "Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial", Ann Emerg Med, 35, pp.229~238 (2000)
- Mehran Sotoodehnia, "Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial", The Korean Journal of Pain, 32(2), pp.97~104 (2019), 대한통증학회[DOI]
- Svenson JE, "Ketamine for prehospital use : new look at an old drug", Am J Emerg Med, 25, pp.977~980 (2007)
- Pasero C, "Pain control : ketamine : low doses may provide relief for some painful conditions", Am J Nurs, 105, pp.60~64 (2005)
- Oyedepo OO, "Efficacy and safety of oral ketamine premedication in children undergoing day case surgery", J West Afr Coll Surg, 6, pp.1~15 (2016)
- Gutstein HB, "Oral ketamine preanesthetic medication in children", Anesthesiology, 76, pp.28~33 (1992)
- Rostaminezhad A, "A study on oral ketamine premedication effects on preparation of children for surgery", Armaghane Danesh, 6, pp.1~7 (2001)
- Oriby ME, "Comparison of intranasal dexmedetomidine and oral ketamine versus intranasal midazolam premedication for children undergoing dental rehabilitation", Anesth Pain Med, 9, pp.e8522~ (2019)
- Soleimanpour H, "Effectiveness of oral ketamine, midazolam, and atropine cocktail versus oral diphenhydramine for pediatric sedation in the emergency department", Iran Red Crescent Med J, 16, pp.e21366~ (2014)
- Kamel AAF, "Analgo-sedative effects of oral or nebulized ketamine in preschoolers undergoing elective surgery : a comparative, randomized, double-blind study", Pain Physician, 23, pp.E195~E202 (2020)
- Majidinejad S, "Oral midazolam-ketamine versus midazolam alone for procedural sedation of children undergoing computed tomography;a randomized clinical trial", Emerg(Tehran), 3, pp.64~69 (2015)
- Şekerci C, "Oral ketamine premedication in children(placebo controlled double-blind study)", Eur J Anaesthesiol, 13, pp.606~611 (1996)
- Kurdi MS, "Ketamine : Current applications in anesthesia, pain, and critical care", Anesth Essays Res, 8, pp.283~290 (2014)
- Kimiaei Asadi H, "The effect of administration of ketamine and paracetamol versus paracetamol singly on postoperative pain, nausea and vomiting after pediatric adenotonsillectomy", Anesth Pain Med, 6, pp.e31210~ (2016)
- Barkan S, "A double-blind, randomised, placebocontrolled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair", Emerg Med J, 31, pp.649~653 (2014)
- Funk W, "Oral preanaesthetic medication for children : double-blind randomized study of a combination of midazolam and ketamine vs midazolam or ketamine alone", Br J Anaesth, 84, pp.335~340 (2000)
- Turhanoğlu S, "Effects of different doses of oral ketamine for premedication of children", Eur J Anaesthesiol, 20, pp.56~60 (2003)
- Horiuchi T, "Evaluation of relatively low dose of oral transmucosal ketamine premedication in children : a comparison with oral midazolam", Paediatr Anaesth, 15, pp.643~647 (2005)
- Javid MJ, "Evaluation of a low dose ketamine in post tonsillectomy pain relief : a randomized trial comparing intravenous and subcutaneous ketamine in pediatrics", Anesth Pain Med, 2, pp.85~89 (2012)
- Hatton RC, "Use of oral ketamine by academic hospitals in the US", Ann Pharmacother, 47, pp.591~592 (2013)
- Kalra P, "Miller’s anesthesia, volumes 1 and 2, 7th edition", Anesthesiology, 112, pp.260~261 (2010)
- Kubota R, "Pharmacokinetics of ketamine and norketamine after oral administration of a liquid formulation of ketamine", J Curr Surg, 3, pp.82~86 (2013)
- Soto E, "Oral ketamine in the palliative care setting : a review of the literature and case report of a patient with neurofibromatosis type 1 and glomus tumor-associated complex regional pain syndrome", Am J Hosp Palliat Care, 29, pp.308~317 (2012)
- Ozdemir D, "Ketamine and midazolam for invasive procedures in children with malignancy : a comparison of routes of intravenous, oral, and rectal administration", J Trop Pediatr, 50, pp.224~228 (2004)
- "Ketamine (Rx). Medscape Reference" (2022)[URL]
- Tobias JD, "Oral ketamine premedication to alleviate the distress of invasive procedures in pediatric oncology patients", Pediatrics, 90, pp.537~541 (1992)
- Beebe DS, "Effectiveness of preoperative sedation with rectal midazolam, ketamine, or their combination in young children", Anesth Analg, 75, pp.880~884 (1992)
- Narendra PL, "A comparison of intranasal ketamine and intranasal midazolam for pediatric premedication", Anesth Essays Res, 9, pp.213~218 (2015)
- Motamed F, "Midazolam-ketamine combination for moderate sedation in upper GI endoscopy", J Pediatr Gastroenterol Nutr, 54, pp.422~426 (2012)
- Norambuena C, "Oral ketamine and midazolam for pediatric burn patients : a prospective, randomized, double-blind study", J Pediatr Surg, 48, pp.629~634 (2013)
- Qureshi FA, "Efficacy of oral ketamine for providing sedation and analgesia to children requiring laceration repair", Pediatr Emerg Care, 11, pp.93~97 (1995)
- Jain K, "Efficacy of two oral premedicants : midazolam or a low-dose combination of midazolam-ketamine for reducing stress during intravenous cannulation in children undergoing CT imaging", Paediatr Anaesth, 20, pp.330~337 (2010)
- Green SM, "Ketamine sedation for pediatric procedures : part 2, review and implications", Ann Emerg Med, 19, pp.1033~1046 (1990)
- Petrack EM, "Ketamine", Clin Pediatr Emerg Med, 1, pp.281~284 (2000)
- Visintainer MA, "Psychological preparation for surgery pediatric patients : the effects on children’s and parents’stress responses and adjustment", Pediatrics, 56, pp.187~202 (1975)
- Schechter NL, "The use of oral transmucosal fentanyl citrate for painful procedures in children", Pediatrics, 95, pp.335~339 (1995)
- Saarnivaara L, "Comparison of chloral hydrate and midazolam by mouth as premedicants in children undergoing otolaryngological surgery", Br J Anaesth, 61, pp.390~396 (1988)
- Kil HK, "Psychological and behavioral effects of chloral hydrate in day-case pediatric surgery : a randomized, observer-blinded study", J Pediatr Surg, 47, pp.1592~1599 (2012)
- Hamid M, "Effectiveness of premedication at the time of separation from parent and mask induction in paediatric patients coming for congenital heart disease surgery", J Coll Physicians Surg Pak, 22, pp.280~284 (2012)
- Sajid B, "A comparison of oral dexmedetomidine and oral midazolam as premedicants in children", J Anaesthesiol Clin Pharmacol, 35, pp.36~40 (2019)
- 김경훈, "Safe Sedation and Hypnosis using Dexmedetomidine for Minimally Invasive Spine Surgery in a Prone Position", The Korean Journal of Pain, 27(4), pp.313~320 (2014), 대한통증학회
