1) All sedatives have side effects. We should have the enough skills to
deal with them
2) The incidence of dreaded emergence phenomena side effects in children
is small.
3) Benzodiazepines have side effects too. Dysphoric reactions could be as
frightening as the above side effects and the incidence reported is as large
as the incidence reported for emergence phenomena when using ketamine
4) If you have a severe emergence phenomena you can try to treat it with
midazolam and probably will work but I agree with Rowley, you are
introducing another possible source of complications.
5) Most of us have anecdotal experiences with any sedatives but the facts
are :
- ketamine use by non-anaesthesiologists have been
reported in more than 15000 case (nearly 2000 by
emergency physicians ) with its safety well proven.
- ketamine has been compared with other sedatives and
(although small trials) ketamine has always shown
superior sedation and similar incidence of side
effects
Ketamine is one of the many drugs that we could use to sedate children. I am
not advocating that we should only use ketamine or that everybody should
sedate children. Ketamine is one of the many options that we have and ,in
some circumstances ,I believe could be the best option and its in the scope
of skills expected from emergency physician.
Andres Izquierdo-Martin
Specialist Registrar in Emergency Medicine
North Thames (East) Region
----- Original Message -----
From: "Tony Adams" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, February 17, 2001 9:53 AM
Subject: Re: chemical restraint
> I've managed emergence from ketamine successfully using aliquots of
> midazolam as this helped to ease the way back to reality.
> At least both the child's parents and I thought that midazolam made a
> difference, but that's anecdotal.
>
> I would strongly advise NOT to use Ketamine where side-effects such as
> hallucinations, vivid dreams etc. might exacerbate the condition you're
> trying to manage, such as the agitated, combative patient described in the
> original posting.
>
> Tony Adams
>
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