Emergency medicine journal : EMJ
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Randomized Controlled Trial Comparative Study Clinical Trial
Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation.
This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department. ⋯ Intravenous ketamine plus midazolam used in an appropriate setting by experienced personnel provides an excellent means of achieving sedation suitable for most non-painful minor procedures for children in the emergency department. This combination is superior to INM in terms of speed of onset and consistency of effect. INM delivered via aerosol spray has a more variable effect but may still be adequate for the completion of many of these procedures.
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Randomized Controlled Trial Clinical Trial
Sedation for children requiring wound repair: a randomised controlled double blind comparison of oral midazolam and oral ketamine.
To compare the efficacy of oral ketamine (10 mg/kg) with oral midazolam (0.7 mg/kg) in providing sedation for suturing of lacerations. ⋯ At these doses tolerance to LA injection was better in children receiving ketamine, with fewer behavioural changes noted in the first two weeks. Midazolam at this dose caused dysphoric reactions, which may have affected the results. Continuous pulse oximetry monitoring is required when using these drugs. Vomiting and prolonged ataxia occurred in a few patients.
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For pre-hospital spinal immobilisation the spinal board is the established gold standard. There are concerns that its subsequent use in hospital may adversely affect patient outcome. This review examines the effect of prolonged patient immobilisation on the spinal board. ⋯ The spinal board should be removed in all patients soon after arrival in accident and emergency departments, ideally after the primary survey and resuscitation phases.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intramuscular ketamine with high dose intramuscular midazolam with and without intranasal flumazenil in children before suturing.
(a) To compare the use of high dose intramuscular midazolam with and without intranasal flumazenil in children after suturing. (b) To compare the use of high dose intramuscular midazolam with low dose intramuscular ketamine in children before suturing. ⋯ Intramuscular midazolam (0.4 mg/kg) did not effectively sedate the children, in that a significant number still had to be restrained. However, none could remember the suturing. Intranasal flumazenil seems to be effective in shortening the time to discharge. If midazolam is to be used then a dose high enough to produce full amnesia should be used, there seems to be no advantage in increasing the dose further. Low dose intramuscular ketamine remains the drug of choice.