The right dose of any drug is enough. If the child is going to tolerate
having local put in, which is a much more stimulant procedure, why not just
go ahead and suture?
I agree that it is not good practice to give a benzodiazepine. As I have
argued here before, they should not be given in adults either unless the
patient is hallucinating on emergence in which case a small dose will
provide antegrade and retrograde amnesia.
Best wishes
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 23 December 2005 07:55
To: [log in to unmask]
Subject: Re: Ketamine failure
I hardly think giving local anaesthesia counts as "polypharmacy"; that's a
bit of poetic licence too far if you ask me, unless you mean adding benzos
to the regime (which most of us don't do for kids). And I disagree that
4mg/kg is a tiny dose or that it's "unpredictable" as you suggest. In the
vast majority of my cases, close on 99%, I can get reliable dissociative
sedation with that dose. I'm not about to double my dose regime just to
catch that last 1 or 2% of kids, when the worst that happens is I have to
add a small supplement at the 10-minute mark. And I'm certainly not going
to comply with Prof Dundee's recommendations back from the era when the
drug was first introduced as a GA induction agent.
AF
On Thu, 22 Dec 2005 21:08:21 -0000, Rowley Cottingham
<[log in to unmask]> wrote:
>I am well aware of the recommendations from Green et al and disagree
>with them. It is utterly pointless to faff about with a tiny dose of a
>safe drug in order to give another tiny dose of another drug. It's
>simply bad
medicine
>to do unnecessary polypharmacy, especially when the doses used run the
>risk of unpredictable effects, as pb found.
>
>The 10mg/kg dose was that originally recommended in (IIRC 1973) by
>Dundee
et
>al (again from memory - I have all the original papers up in the study
>but little enthusiasm right now to find the right one) and was
>recommended as such for the pharmacokinetic reasons I gave. Give the
>right dose (enough) and forget the local.
>
>Best wishes
>
> Rowley.
>
>-----Original Message-----
>From: Accident and Emergency Academic List
>[mailto:[log in to unmask]] On Behalf Of Ray
>Sent: 22 December 2005 19:17
>To: [log in to unmask]
>Subject: Re: Ketamine failure
>
>In children I have done hundreds of ketamine sedations now, so I can
>confidently say that it takes about 5 minutes or so before the child is
>ready for the local and if you wait 20 minutes then you have "missed
>the boat" at least on the low dose I'm using IM.
>
>The 4 mg/kg im is the dose recommended by Green in the USA
>
>Ray
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