Comparison of Intranasal Ketamine and Midazolam in Peripheral IV Access in Children Presenting to the Emergency Department, a Randomized Clinical Trial
Shabahang Jafarnejad, Iman Mehrabi, Mahdi Rezai, Hamidreza Khoshnezhad Ebrahimi
1412
ABSTRACTBackground: Peripheral Intravenous (IV) line, despite being the cornerstone of treatment in emergency care, remains the most common anxiety and pain-inducing experience for children.Aim: To compare the clinical efficacy of intranasal (IN) administration of midazolam and ketamine in managing pain and distress associated with peripheral IV access in children presenting to emergency departments (ED).Method: This study is an open-label, controlled clinical trial. Seventy children between the ages of 2 and 8, presenting to the EDs of Iran University of Medical Sciences, were divided into groups of 35. 0.2mg/kg of midazolam or 5mg/kg ketamine was administered intranasally, with the use of a syringe, twenty minutes before the procedure. The sedation & analgesia score was obtained using the Observational Score of behavioral Distress-Revised (OSBD-R). The procedure success was defined as an OSBD-R less than five and no need for physical restraint. The P-value of less than 0.05 was considered significant.Results: 82.9% in the ketamine group and 85.7% in the midazolam group had successful procedures. 17.1% in the ketamine group and 14.3% in the midazolam group had unsuccessful procedures. There was no significant difference regarding the success of the procedure between the two groups (P-Value= 0.743). The mean OSBD-R score was 3.51 in the ketamine group and 3.56 in the midazolam group. There was no significant difference between the two groups in the OSBD-R score (P-Value= 0.852). There was no difference between the vital signs in the two groups. No adverse effects requiring intervention were noted.Conclusion: There is no difference in the clinical efficacy of IN ketamine and midazolam in sedation & analgesia before obtaining peripheral IV access in children. IN ketamine provides adequate sedation before obtaining peripheral IV access in the ED, and it could be considered an ideal medication for this purpose.Keywords: Peripheral IV access in children, Ketamine, Midazolam, Intranasal, IN Emergency Department, ED
Background: Peripheral Intravenous (IV) line, despite being the cornerstone of treatment in emergency care, remains the most common anxiety and pain-inducing experience for children.
Aim: To compare the clinical efficacy of intranasal (IN) administration of midazolam and ketamine in managing pain and distress associated with peripheral IV access in children presenting to emergency departments (ED).
Method: This study is an open-label, controlled clinical trial. Seventy children between the ages of 2 and 8, presenting to the EDs of Iran University of Medical Sciences, were divided into groups of 35. 0.2mg/kg of midazolam or 5mg/kg ketamine was administered intranasally, with the use of a syringe, twenty minutes before the procedure. The sedation & analgesia score was obtained using the Observational Score of behavioral Distress-Revised (OSBD-R). The procedure success was defined as an OSBD-R less than five and no need for physical restraint. The P-value of less than 0.05 was considered significant.
Results: 82.9% in the ketamine group and 85.7% in the midazolam group had successful procedures. 17.1% in the ketamine group and 14.3% in the midazolam group had unsuccessful procedures. There was no significant difference regarding the success of the procedure between the two groups (P-Value= 0.743). The mean OSBD-R score was 3.51 in the ketamine group and 3.56 in the midazolam group. There was no significant difference between the two groups in the OSBD-R score (P-Value= 0.852). There was no difference between the vital signs in the two groups. No adverse effects requiring intervention were noted.
Conclusion: There is no difference in the clinical efficacy of IN ketamine and midazolam in sedation & analgesia before obtaining peripheral IV access in children. IN ketamine provides adequate sedation before obtaining peripheral IV access in the ED, and it could be considered an ideal medication for this purpose.
Keywords: Peripheral IV access in children, Ketamine, Midazolam, Intranasal, IN Emergency Department, ED