No, the opposite in fact. I use 2 mg/kg with routine local anaesthetic. The
only case of laryngospasm in our series was using 2.5 mg/kg ... it was the
first case our SpR did, but he still uses Ketamine. Green had a higher
although still relatively low incidence of airways problems using 4 mg/kg
(see PDF poster). BUT what's really needed to answer the question is a
randomised study using different doses.
We don't do manipulations at this low dose.
Ray McGlone
A&E Lancaster
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, January 15, 2003 8:43 PM
Subject: Re: SIGN Paediatric Sedation Guidelines
> Renee, far be it from me to answer on Steve's behalf, but i.m. is
incredibly predictable. It saves us from having to find i.v. access, and it
probably produces a longer period of "operability".
>
> And Ray, you said you had one case of spasm in a patient that received
2.5mg/kg. I take it that you're implying that you tend not to see spasm with
higher doses. I have moved from 4mg/kg towards 5mg/kg over the last year
just to improve sedation; I basically calculate 4mg/kg but round it up to
the nearest round number so as not to drive the nurses mad! I have not yet
seen spasm with ketamine, but I think it can be avoided by:
>
> 1)using adequate dosage of ketamine.
> 2)witholding surgery until well sedated.
> 3)ensuring secretions are under control but...
> 4)not suctioning if you don't need to!
> 5)using local to augment sedation.
> 6)witholding surgery if there is excessive breatholding, hiccupping or
phonation, and consider more ketamine or more local if these don't settle
down.
>
> Do you have any other tips or tricks?
>
> AF
>
> > from: Renee Nilan <[log in to unmask]>
> > date: Wed, 15 Jan 2003 19:38:36
> > to: [log in to unmask]
> > subject: Re: SIGN Paediatric Sedation Guidelines
> >
> > Steve,
> >
> > Why do you prefer IM to IV route? Isn't onset with IV more rapid and
> > predictable? You'll have to excuse my ignorance but I haven't tried it
IM,
> > only IV.
> >
> > Renee
>
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