Nora

Cote,C,Charles,J,Helen,W,Notterman,DA,Daniel A.,Weinberg JA,Mc CLoskey C. Adverse sedation

events in pediatrics ;analysis of medication used for sedation.

Pediatrics 106:…..:2000.

not harmed(+extra Hosp stay)death

permanentneurol injury

118 cases from the adverse drug reporting System of the FDA,US Pharmacopeia and a results of a survey of

pediatric specialists

Allocation of medication related adverse events

drug interaction

drug overdose

prematuredischarge

prescr/transcription error

idadequnderstanding ofadm.medicationsadm byunsupervisedtechnicianparent adm

Relationship of interest of negative outcome

• No with general category of drug

• No with route of administration

• Yes with 3 or > sedation medications

• 12 pts suffered at home or in auto;chloral hydrate most frequently involved

• Dental specialists overrepresented:39%!

• RCTRCT

• MRI and CT (01/MRI and CT (01/’’97-01/97-01/’’98 from 0 to 18 yr)98 from 0 to 18 yr)

• University of Michigan Health Care University of Michigan Health Care SystemsSystems

• Sedation (922) / GA (140)Sedation (922) / GA (140)

0%

10%

20%

30%

ASA 1-2 ASA 3-4

Not Adequate sedation/ASA

0

2

4

6

Adequate Not Adequate

Sedation

Sedation/Age

Sedation and general anaesthesia in children Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and undergoing MRI and CT: adverse events and

outcomes.outcomes.Malvija S. et al. Br. J. Anaesth. 84:743-8, 2000Malvija S. et al. Br. J. Anaesth. 84:743-8, 2000

Sedative Sedative Mean Mean DosagDosage (SD)e (SD)

Oxygen Oxygen desaturatiodesaturatio

nn (=27) (=27)

Airway Airway managememanageme

ntnt (=9) (=9)

InadequaInadequate te

sedation sedation (=146)(=146)

OversedatiOversedationon (=4) (=4)

Failed Failed procedurprocedureses (=65) (=65)

Single agentSingle agent

• Chloral Chloral Hydrate (679)Hydrate (679)

69 69 (9.9) (9.9)

mg/kgmg/kg21 (3%)21 (3%) 7 (1%)7 (1%) 63 (9%)63 (9%) 4 (<!%)4 (<!%) 26 (4%)26 (4%)

• BDZ (90)BDZ (90) 1 (1%)1 (1%) 00 17 (19%)17 (19%) 00 8 (9%)8 (9%)

• Barbiturate (2)Barbiturate (2) 00 00 00 00 00

Multiple agentsMultiple agents

• Anxiolytic Anxiolytic combination combination (117)(117)

2 (2%)2 (2%) 1 (<1%)1 (<1%) 59 (50%)59 (50%) 00 28 (24%)28 (24%)

• Analgesic-Analgesic-anxiolytic anxiolytic combination (7)combination (7)

1 (14%)1 (14%) 00 1 (14%)1 (14%) 00 00

Sedative agents and adverse Sedative agents and adverse eventsevents

Malvija S. et al. Br. J. Anaesth. 84:743-8, 2000Malvija S. et al. Br. J. Anaesth. 84:743-8, 2000

Sedation procedures in MRI imaging: safety, Sedation procedures in MRI imaging: safety, effectiveness, and nursing effect on effectiveness, and nursing effect on

examinations.examinations.

• John Hopkins Hospital, Baltimore 1991-1998John Hopkins Hospital, Baltimore 1991-1998• 6.093 patients, 4.761 (78,1%) received conscious 6.093 patients, 4.761 (78,1%) received conscious

sedation by the MR conscious sedation servicesedation by the MR conscious sedation service• Complications: 20 patients of 4.761 (0,42%), no death.Complications: 20 patients of 4.761 (0,42%), no death.

Bluemke D. et al. Radiology 216:645-52, 2000Bluemke D. et al. Radiology 216:645-52, 2000

325

84164

195 183125

84

0

100

200

300

400

N°

10-20 20-30 30-40 40-50 50-60 60-70 70-100

Age

Age range

Medication Dose Indication

0-3 Chloral Hydrate80-100 mg/kg

Sedative-hypnotic

3-7 Pentobarbital 4-6 mg/kgSedative-hypnotic

7-18 Diazepam 0.2 mg/kgAntianxiety-

sedative

>18 Alprazolam 0.5 mg/23kgAntianxiety-

sedative

2081

48

588

1498

497490

500

1000

1500

2000

2500

CH D i.v. D os P A O

Failed sedationN° pts

CH: Chloral hydrate

D: Diazepam

P: Pentobarbital

A: Alprazolam

O: Other

M: Midazolam

4,8%

6,2%

13,1%

4,9%

9,4%

16%

Adverse Event during Conscious Sedation

0

1

2

3

4

5

6

CH M P

N°

pati

en

ts

Agitation

Bronchospasm

Congestion andcoughing

Hypotension

Desaturation

Seizure

Vomiting

Sedation procedures in MRI imaging: safety, effectiveness, and nursing effect on Sedation procedures in MRI imaging: safety, effectiveness, and nursing effect on examinations.examinations. Bluemke D. et al. Radiology 216:645-52, 2000Bluemke D. et al. Radiology 216:645-52, 2000

• Complete MR examination: 93,5%

• Mean time to sedate patients:

• 23,6 ± 15,2 min for specialized MR nurses

• 26,8 ± 20,1 min for general radiology nurses (p<0.001)

MacIntyre PA,Sury MRI.Is propofol infusion better than inhalational anesthesia for

paediatric MRI?Anaesthesia 51;517,1996

43 children43 children

6 difficult veins6 difficult veins 3 intrascan airway manipulations3 intrascan airway manipulations 3 abandonement of technique3 abandonement of technique

HalothHaloth induction induction 9 repetition of scan sequences9 repetition of scan sequencesSaO2 88-89% in 6SaO2 88-89% in 6

Induction with propofol 1-3 mg/kgInduction with propofol 1-3 mg/kgMaint:propofol 5 mg/kg/hMaint:propofol 5 mg/kg/h

30 required additional boluses 30 required additional boluses of propofol 1 mg/kg;of propofol 1 mg/kg;

In 5, 2-3 mg/kgIn 5, 2-3 mg/kg

Recovery < 3 min,but in 9 >10 minRecovery < 3 min,but in 9 >10 min

Vangerven M.,Van Hemelriick J,Wouters P,Vandermeersch E,Van Aken,H.Light

anesthesia with propofol for paediatric MRIAnaesthesia 47;706-7,1992

• 20 children,1 mo-12 years from neuropediatrics

• Atropine syrup 0.02 mg/kg

• Propofol induct 1 + 8 mg/kg/hr

Vangerven M.,Van Hemelriick J,Wouters P,Vandermeersch E,Van Aken,H.Light

anesthesia with propofol for paediatric MRIAnaesthesia 47;706-7,1992

0

1

2

3

4

5

6

7

3 10 20 30

min

PECO2

additional boluses

mean tot prop dose

•SaO2 99%SaO2 99%

Initial experience with i.v. pentobarbital sedation for Initial experience with i.v. pentobarbital sedation for children undergiong MRI at a tertiary care pediatric children undergiong MRI at a tertiary care pediatric

hospital: the learning curvehospital: the learning curve

• 100 children in MRI (ASA I-II); 2-15 ys with mean age of 6,8 ys100 children in MRI (ASA I-II); 2-15 ys with mean age of 6,8 ys• Weight from 11,4 to 70 kg with a mean of 28 kgWeight from 11,4 to 70 kg with a mean of 28 kg• Max 6 mg/kg pentobarbital in 3 divided doses with total dose Max 6 mg/kg pentobarbital in 3 divided doses with total dose ≤ ≤

200 mg administrated by radiologists (PALS certificated)200 mg administrated by radiologists (PALS certificated)

Greenberg et al. Pediatr Radiol 30:689-691, 2000Greenberg et al. Pediatr Radiol 30:689-691, 2000

92

8

0

20

40

60

80

100

Sedation

Failed

Successful

3 > 12 y old*

3 > 50 kg*

(*p < 0.05)

Initial experience with i.v. pentobarbital sedation for Initial experience with i.v. pentobarbital sedation for children undergoing MRI at a tertiary care pediatric children undergoing MRI at a tertiary care pediatric

hospital: the learning curvehospital: the learning curve

Greenberg et al. Pediatr Radiol 30:689-691, 2000Greenberg et al. Pediatr Radiol 30:689-691, 2000

7

6

3

2

1 1

0123456789

10

Nu

mb

er o

f ca

ses

Adverse reaction

Hyperreaction

Desaturation

Cough

Prolongedsedation

Nasal congestion

Vomiting

Adverse reaction to Pentobarbital in 100 children

Intravenous sedation for MR Imaging of the brain and Intravenous sedation for MR Imaging of the brain and spine in children: Pentobarbital vs Propofolspine in children: Pentobarbital vs Propofol

• RCT from April 1991 to February 1992 (Cleveland Clinic Foundation)RCT from April 1991 to February 1992 (Cleveland Clinic Foundation)• 30 pts received i.v. Pentobarbital 2,5 mg/kg (to a max of 7,5 mg/kg) by radiologists30 pts received i.v. Pentobarbital 2,5 mg/kg (to a max of 7,5 mg/kg) by radiologists• 31 pts received i.v. Propofol 1-2 mg/kg + 6-10 mg/kg/h (premed. 0.05/12 Kg 31 pts received i.v. Propofol 1-2 mg/kg + 6-10 mg/kg/h (premed. 0.05/12 Kg

glycopyrrolate) first 10 by anesthesiologists then by radiologists (Control- A-Flow glycopyrrolate) first 10 by anesthesiologists then by radiologists (Control- A-Flow Regulator Extension Set, Baxter)Regulator Extension Set, Baxter)

Bloomfield E.L. et al. Radiology 186:93-97, 1993Bloomfield E.L. et al. Radiology 186:93-97, 1993

GroupGroup

DataData Propofol (Propofol (nn=31)=31) Pentobarbital (Pentobarbital (nn=30)=30)

Age (y) (mean/range)

Sex (M/F)

Weight (kg) (mean/range)

Original diagnoses:• Seizures• Neurofibromatosis I• Developmental delay• Cerebral palsy• Dysmyelination syndrome• Spinal dysraphism• Chiari malformation• Brain tumor• Infarct• Diskitis• Headache

5 / 2 – 11

15 / 16

20 / 11.5-34.0

10

2

3

4

0

0

2

9

0

0

1

4 / 2 – 8

18 / 12

17.9 / 9-50

11

4

3

2

2

2

2

1

1

1

1



0

20

40

60

80

100

120

PulseSpO2MAPRR

PropofolPropofol PentobarbitalPentobarbital

Mean t=0 % drop % rise Mean% drop

Mean% rise

Mean t=0 % drop % rise Mean% drop

Mean% rise

p=0,05



5

21,5

12,5

34

0

5

10

15

20

25

30

35

40

45

50

Tim

e (

min

)

Arousal Discharge

PentobarbitalPropofol

P=0.0005P=0.0005 P=0.0001P=0.0001

Anaesthesia for magnetic resonance imaging: a survey Anaesthesia for magnetic resonance imaging: a survey of current practice in the UK and Irelandof current practice in the UK and Ireland

• Postal questionnaire was sent to 120 MRI units in UK and 6 in Republic of Ireland

• 100 (79%) responses:– 46 units had an anaesthetic service (36 units on a regular basis, 10 on demand)

McBrien M. E. et al. Anaesthesia 55:737-743, 2000McBrien M. E. et al. Anaesthesia 55:737-743, 2000

12

8

5

0

2

4

6

8

10

12

N°

Un

its

Radiologists Paediatricians Both

Sedation ever provided by nonanaesthetic personnel

21

15

97

0

5

10

15

20

25

N°

Un

its

GAA GPA NAP NA

Sedation provided by anaesthetic consultants

GAA: General Adult AnaesthetistGPA: General Paediatric AnaesthetistNAP: Neuroanaesthetist with regular Paediatric practiceNA: Neuroanaesthetist with no regular paediatric practice


• Written consent for anaesthesia was obtained in 40 units but only 20 units had written information about anaesthesia

• 44 of 46 units providing anaesthesia always had anaesthetic assistance, 2 had occasional assistance

• Remote monitoring in 35 units

29

6

28

1

0

5

10

15

20

25

30

N°

Un

its

OnlyAdults

MainlyAdults

OnlyChildren

MainlyChildren

Notanswered

Patient demographics

23

138

20

5

10

15

20

25

N°

Un

its

A B C D

Preoperative assesment

A: Only at arrival on scanB: On ward prior to scanC: Seen at assesment clinic prior to scanD: Questionnaire returned by referring clinician

15

2 2

27

ABCD

15

2

12

ABC

16

1

29

SBIPPVBoth

A: MR-compatible anaesthetic machine inside the scanning roomB: Long breathing system tubing fed into the scanning room from a remote anaesthetic machineC: Non compatible gas delivery system bolted to the wall insideD: Nothing (only sedation and never GA)

A: remote ventilator in the control room with circuit tubing fed into SRB: Non compatible ventilator attached to the wall insideC: Ambu bags attached to an oxygen supply if ventilator was required

Ventilation

Anaesthetic machine Ventilator

• 15 units had not scavenging of gases in the induction area

• 13 units had not scavenging of gases in the scanning room

• 18 units had a separate recovery room equipped with NIBP, SpO2, ECG


Adverse events and factor associated with the sedation Adverse events and factor associated with the sedation of children by nonanesthesiologistsof children by nonanesthesiologists

Shobha Malviya et al. Anaesth Analg 85:1207-13,1997Shobha Malviya et al. Anaesth Analg 85:1207-13,1997

• University of Michigan Hospital, october 1995-1996University of Michigan Hospital, october 1995-1996• 1.140 children1.140 children• mean age (2,96mean age (2,96±3,7±3,7))• ASA I-II 848 (81%)ASA I-II 848 (81%)• ASA III-IV 199 (19%)ASA III-IV 199 (19%)• MRI 48%MRI 48%• TC 27%TC 27%• Cardiac catheterization 2%Cardiac catheterization 2%• Echocardiogram 20%Echocardiogram 20%• Other 3%Other 3%• Conscious sedation 604, deep sedation 294Conscious sedation 604, deep sedation 294


SedationSedation

Sedative (Sedative (nn))Respiratory Respiratory

eventsevents InadequateInadequate OversedationOversedation Failed Failed proceduresprocedures

Chloral hydrate Chloral hydrate (854)(854) 46 (5,3%)46 (5,3%) 77 (10%)77 (10%) 11 (1,3%)11 (1,3%) 26 (3%)26 (3%)

BDZ (72)BDZ (72) 00 14 (19%)14 (19%) 00 4 (5%)4 (5%)

Anxiolytic Anxiolytic combinatios (123)combinatios (123) 3 (2,4%)3 (2,4%) 39 (32%)39 (32%)** 3 (2,4%)3 (2,4%) 16 (13%)16 (13%)**

Analgesic / Analgesic / anxiolytic anxiolytic combinations (24)combinations (24)

2 (8,3%)2 (8,3%) 00 00 00

Opioid aloneOpioid alone 2 (100%)2 (100%) 1 (50%)1 (50%) 1 (50%)1 (50%) 2 (100%)2 (100%)

Diphenhydramine Diphenhydramine alone (2)alone (2) 2 (100%)2 (100%) 00 00 00

* All included the use of chloral hydrate* All included the use of chloral hydrate

0

20

40

60

80

100

% C

hil

dre

n

ASA I-II ASA III-IV

All events

Respiratory events

****


Relationship of age to the incidence of adverse events Relationship of age to the incidence of adverse events in sedated children. in sedated children. **PP<0.05<0.05

Relationship of age to the incidence of adverse events Relationship of age to the incidence of adverse events in sedated children. in sedated children. **PP<0.05<0.05 ****PP<0.0001<0.0001

0

20

40

60

80

100

% C

hil

dre

n

<1 mo 1-12 mo 13-24 mo 25 mo-12 yr >12-18 yr

All events

Respiratory events

******


SummarySummary• Respiratory depression:Respiratory depression:

– 5,5% experienced hypoxemia, 2 became apneic and 5,5% experienced hypoxemia, 2 became apneic and required resuscitation.required resuscitation.

– Several reports of mild hypoxemia and airway Several reports of mild hypoxemia and airway obstruction requiring IOT in children who received obstruction requiring IOT in children who received chloral hydrate as a sole sedative for CT scan.chloral hydrate as a sole sedative for CT scan.

– Chloral hydrate may selectively depress genioglossus Chloral hydrate may selectively depress genioglossus activity >>>> airway obstructionactivity >>>> airway obstruction

– In this study, chloral hydrate in recommended doses In this study, chloral hydrate in recommended doses (38-83 mg/kg) as a sole drug is associated with a (38-83 mg/kg) as a sole drug is associated with a significant risk of oxygen desaturationsignificant risk of oxygen desaturation

• Importance of diligent monitoring throughout the Importance of diligent monitoring throughout the sedation experience until the child has met discharge sedation experience until the child has met discharge criteria, regardless of the sedative administered or its criteria, regardless of the sedative administered or its route of administration >>>> route of administration >>>> early detection and early early detection and early interventionintervention

• Cotè reported an anecdotal incident of death from the Cotè reported an anecdotal incident of death from the practice of administering chloral hydrate to an infant at practice of administering chloral hydrate to an infant at home before arrival in the hospitalhome before arrival in the hospital

• Inadequate sedation with chloral hydrate (5-15%) Inadequate sedation with chloral hydrate (5-15%) resulted in either a prolonged or a failed procedure.resulted in either a prolonged or a failed procedure.

• A larger portion of children who had received A larger portion of children who had received combinations of sedatives that included chloral hydrate combinations of sedatives that included chloral hydrate experienced inadequate sedation compared with those experienced inadequate sedation compared with those who had received chloral hydrate alone.who had received chloral hydrate alone.

• The individual response to chloral hydrate is varied and The individual response to chloral hydrate is varied and unpredictable.unpredictable.

ConcludingConcluding

• Older children had a greater failure rate (15%) Older children had a greater failure rate (15%) compared with younger children (5%) for chloral compared with younger children (5%) for chloral hydrate sedation.hydrate sedation.

• In older children, it may be preferable to In older children, it may be preferable to consider alternative sedation regimens that consider alternative sedation regimens that combine chloral hydrate with another sedative.combine chloral hydrate with another sedative.

• Prolonged or aborted procedures may be costly Prolonged or aborted procedures may be costly to the institution, as well as inconvenient for the to the institution, as well as inconvenient for the patient, who may be required to return for a patient, who may be required to return for a repeated procedure with general anesthesia.repeated procedure with general anesthesia.

• Neonates and infants less than one year old, Neonates and infants less than one year old, and ASA III-IV all age, are at greater risk of and ASA III-IV all age, are at greater risk of adverse events related to sedation.adverse events related to sedation.

Chloral hydrate toxicityChloral hydrate toxicity• Chloral hydrate is a reactive metabolite of Chloral hydrate is a reactive metabolite of

trichloroethylene, an industrial solvent. Is it trichloroethylene, an industrial solvent. Is it responsible for the carcinogenicity of responsible for the carcinogenicity of trichloroethylene?trichloroethylene?

• The carcinogenicity of richloroethylene is due to a The carcinogenicity of richloroethylene is due to a reactive intermediate epoxide metabolite.reactive intermediate epoxide metabolite.

• Trichloroethylene is carcinogenic in some laboratory Trichloroethylene is carcinogenic in some laboratory animal species but not in others.animal species but not in others.

• Multiple epidemiologic studies in humans have failed Multiple epidemiologic studies in humans have failed to document an increase in cancer incidence.to document an increase in cancer incidence.

Randomised double-blind clinical trial of intermediate Randomised double-blind clinical trial of intermediate vsvs high-dose chloral hydrate for neuroimaging of high-dose chloral hydrate for neuroimaging of

childrenchildren

• Background:Background:– Recommended paediatric dose is 50 mg/kg orally.Recommended paediatric dose is 50 mg/kg orally.

– Previous study shown a successfull of sedation in 90% of cases with Previous study shown a successfull of sedation in 90% of cases with 70 mg/kg orally.70 mg/kg orally.

– Higher doses did not seem justified (risk of prolonged sedation, rising of Higher doses did not seem justified (risk of prolonged sedation, rising of adverse reaction)adverse reaction)

– Some studies have concluded that 100 mg/kg provides effective and Some studies have concluded that 100 mg/kg provides effective and safe sedation (Greenberg 1993).safe sedation (Greenberg 1993).

Martì-Bonmatì et al. Neuroradiology 1995;37:687-691Martì-Bonmatì et al. Neuroradiology 1995;37:687-691

Randomised double-blind clinical trial of intermediate Randomised double-blind clinical trial of intermediate vsvs high-dose chloral hydrate for neuroimaging of high-dose chloral hydrate for neuroimaging of

childrenchildren

• Materials and methodsMaterials and methods::– 97 children undergoing MRI (Valencia University)97 children undergoing MRI (Valencia University)– Mean age 38 Mean age 38 ± 31 month± 31 month– Mean weight 14,7 ± 6,4 kgMean weight 14,7 ± 6,4 kg– Randomized (double-blind) in two groups:Randomized (double-blind) in two groups:

• A Group: 70 mg/kg of orally syrup 30 min before scanningA Group: 70 mg/kg of orally syrup 30 min before scanning• B Group: 100 mg/kg of orally syrup 30 min before scanningB Group: 100 mg/kg of orally syrup 30 min before scanning

– OO22 supplementation during exam supplementation during exam– Indications:Indications:

• Congenital craniocerebral abnormalities (33)Congenital craniocerebral abnormalities (33)• Epilepsy (21)Epilepsy (21)• White matter disease (11)White matter disease (11)• Development delay (11)Development delay (11)• Congenital spine disease (10)Congenital spine disease (10)• Cerebral-spinal tumor (11)Cerebral-spinal tumor (11)


64

9287

100

0

20

40

60

80

100

% S

ucc

essf

ul

exam

inat

ion

Group A Group B

Initial dose

Total dose

p < 0,05

(70 mg/kg) (100 mg/kg)

Percentage of effectiveness after the initial dosePercentage of effectiveness after the initial doseand the total dose and the total dose


28,5

43

28,5

55

30

15

0

10

20

30

40

50

60

Deg

ree

of

acce

pta

nce

%

70 mg/ml 100 mg/kg

Bad

Medium

Good

Degree of of acceptance of the two syrupsDegree of of acceptance of the two syrupsby the childrenby the children

Chi-squared: p < 0,05Chi-squared: p < 0,05


Initial and the total dose in patientsInitial and the total dose in patientswith failed and successful axamination with failed and successful axamination

50

60

70

80

90

Do

se (

mg

/kg

)

Initial dose Total dose

Failure

Successful examination

p < 0,05p < 0,01


10%

5% 5%

80%

Vomiting

Excitement

Nausea

Stomach pain


Adverse reactions (21%) was similar in both groups A-BAdverse reactions (21%) was similar in both groups A-B

Anaesthesia with midazolam and S-(+)-ketamine in Anaesthesia with midazolam and S-(+)-ketamine in spontaneously breathing paediatric patients during MRIspontaneously breathing paediatric patients during MRI

Haeseler G, et al. Paediatric Anaesthesia 2000;10:513-519Haeseler G, et al. Paediatric Anaesthesia 2000;10:513-519

• RCT studyRCT study

• Department of Anaesthesiology, Hannover Medical Department of Anaesthesiology, Hannover Medical SchoolSchool

• MRI from april 1998 to march 1999MRI from april 1998 to march 1999

Materials and methodsMaterials and methods::

• Prospective study of 34 patients (8 months – 7 years) undergoing Prospective study of 34 patients (8 months – 7 years) undergoing MRIMRI– Randomized in two groups:Randomized in two groups:

• 1st Group: 1st Group: Premedication with 0,5 mg/kg of rectal midazolamPremedication with 0,5 mg/kg of rectal midazolam Induction with 3-5 mg/kg of methohexital, 0,5 mg/kg Induction with 3-5 mg/kg of methohexital, 0,5 mg/kg

atracuriumatracurium IOT and IPPV (FiO2 0,4, End tidal Isoflurane 1 IOT and IPPV (FiO2 0,4, End tidal Isoflurane 1 ± 0,3%± 0,3%))

•2nd Group:2nd Group:premedication with 0,5 mg/kg of rectal midazolam and 5 mg/kg of S-(+)-premedication with 0,5 mg/kg of rectal midazolam and 5 mg/kg of S-(+)-ketamineketamineOO22 supply 2-3 L/min by two nasal prongs supply 2-3 L/min by two nasal prongsContinuous nasopharyngeal EtCOContinuous nasopharyngeal EtCO22 monitoring monitoring0,05 mg/kg midazolam and 0,25 mg/kg S-(+)-ketamine until adequate 0,05 mg/kg midazolam and 0,25 mg/kg S-(+)-ketamine until adequate immobilizationimmobilization

All patients received 0,01 mg/kg atropine i.v. and 0,05% xylometazoline nasalAll patients received 0,01 mg/kg atropine i.v. and 0,05% xylometazoline nasalStandard operating room monitoringStandard operating room monitoring

Haeseler G, et al. Paediatric Anaesthesia 2000;10:513-519Haeseler G, et al. Paediatric Anaesthesia 2000;10:513-519

ResultsResults

0

10

20

30

40

50

60

70

80

90

100

110

120

130

140

Sedation

G.A.

**

* * P < 0,05P < 0,05

-40

-20

0

20

40

60

80

100

120

140T

ime

(m

in)

Sedation

G.A.

Diff.means

* * P < 0,05P < 0,05

****

**

S-(+)-ketamineS-(+)-ketamine

Clinical superiority in anaesthetic Clinical superiority in anaesthetic potency compared to its optical potency compared to its optical enantiomer R-(-)-ketamineenantiomer R-(-)-ketamine

Superiority in recovery timeSuperiority in recovery time

Superiority in neuroprotective effectsSuperiority in neuroprotective effects

Shorter induction and discharge timesShorter induction and discharge times

THANK YOU FOR THANK YOU FOR YOUR ATTENTIONYOUR ATTENTION

• D:Anesth outside OR Gurman • D:bis e tci modena• D:propofol tci e bis monitoring dentro bis monit

and consciousness• RMN• Propofol tci e anest reg modena;il + completo

per la metodica……………. • Modena 12403komplet• Macmida per le scale di sedaz

Nora

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