PROCEDURAL SEDATION AND ANALGESIA IN PEDIATRICS
Rajeswari N*, Suchitra R**, Deepika ***
Dept of PICU, Apollo Hospitals, Chennai. *, Dept of PICU, Apollo Hospitals, Chennai. **, Dept of PICU, Apollo Hospitals, Chennai. ***
Objectives
A pilot study to assess efficacy and safety of titrated doses of sedatives and analgesics in procedural sedation.
Methods
Five cases were included in the study from Jan 2005 onwards. Brief history, physical examination including oropharyngeal examination and categorization under ASA classification were carried out and all cases were kept NBM for three hours prior to the procedure. Midazolam / ketamine / glycopyrrolate, midazolam / propofol combinations were given for various noninvasive (painless) and invasive procedures.

Airway integrity, pulse and respiratory rates, oxygen saturation and Ramsay sedation scoring were documented every 5 minutes until recovery.
Results
Of the 35 cases enrolled in our study, 14 cases received ketamine and midazolam combination as titrated boluses at half the recommended doses and 13 cases received midazolam / propofol. Three patients received propofol along as bolus followed by infusion for MRI. The remaining 5 cases received midazolam along for short imaging studies. All complications were observed in the 3 patients that received only propofol. None of the patients on midazolam / ketamine / glycopyrrolate had untoward complications.
Conclusion
The interim results of this small pilot study appears to indicate that -
  1. Titrated boluses of small dose of midazolam / ketamine combinations appear to minimize side effects with good analgesia and amnesia and early recovery.
  2. Propofol bolus followed by infusions may be associated with significant complications.
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