• Dilek Dilli, Yildiz Dallar, and Nihan H Sorgui.
• Department of Pediatrics, Ministry of Health, Ankara Training and Research Hospital, Turkey. dilekdilli2@yahoo.com
• Indian Pediatr. 2008 Nov 1;45(11):899-904.

ObjectiveTo compare a combined dose of ketamine and midazolam versus ketamine alone in the sedation of children requiring lumbar puncture.Study DesignA randomized, controlled study, conducted between January 2004 and December 2006.SettingThe Pediatric Emergency Department (PED) at Ankara Training and Research Hospital, Turkey.ParticipantsA random sample of 99 children (59 boys, 40 girls) aged 2-14 years (mean age 6.5+/-3.7) undergoing lumbar puncture.InterventionParticipants were randomized to receive intravenous (IV) ketamine only (1 mg/kg; IVK) (n=51) or ketamine plus midazolam (1 mg/kg ketamine+0.1 mg/kg midazolam; IVKM) (n=48).Main Outcome MeasuresThe mean time to sedation and adverse events.ResultsThe mean time to sedation was significantly shorter in the IVKM group than the IVK group (2.6+/-1.1 and 3.4+/-1.7 min, respectively; P=0.01). The parental satisfaction was significantly higher in the IVKM group (P=0.001). Also the fasting time and recovery time did not differ between groups, nor was there a significant difference in nausea/vomiting between groups. Nightmares or crying spells were more common in the IVK group than in the IVKM group (P=0.04).ConclusionsWe conclude that adding midazolam to ketamine did not increase the frequency of adverse events and that the combined sedative was superior to ketamine alone in terms of speed of sedation and parental satisfaction.

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