Document Type : Original Article
Authors
Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Painful diagnostic and therapeutic procedures performed for children are routine actions. Opioids and nonsteroidal anti-inflammatory drugs such as acetaminophens are among medications that can be used for this purpose. This study aimed to compare the onset and duration of action of intrabuccal (IB, submucosal) space and intramuscular (IM) injection of ketamine in pediatrics. Materials and Methods: This clinical trial study was carried out on 126 children of 1–15 years old referred to the emergency room of Al-Zahra and Kashani Hospitals in Isfahan and divided into two 63 populated groups of IM and IB. For one group randomly, 3 mg/kg IB ketamine was administered, and for another group, ketamine was injected intramuscularly at the dose of 5 mg/kg. The drug effect, surgeon satisfaction, and complications were evaluated. Data were analyzed using SPSS software. Results: The mean of time between injection and onset of drug effect in IM group was 5.71 min, whereas in IB group, it was 4.14 min (P < 0.0001). The mean of the duration of drug effect in IM group was 45.54 min, whereas in IB group, it was 24.63 min (P < 0.0001). Complications in IM group were significantly more reported than IB group (33.3% versus 11.1%, respectively, P = 003). The median of surgeon satisfaction in IM group was 3 and in IB group was 4 which was statistically significant (P = 0.007). Conclusions: IB method is preferred over IM method, and hence, it is recommended to use.
Keywords
1. |
Heidari SM, Mirlohi SZ, Hashemi SJ. Comparison of the preventive analgesic effect of rectal ketamine and rectal acetaminophen after pediatric tonsillectomy. Int J Prev Med 2012;3:S150-5. [PUBMED] |
2. |
Mion G, Villevieille T. Ketamine pharmacology: An update (pharmacodynamics and molecular aspects, recent findings). CNS Neurosci Ther 2013;19:370-80. [PUBMED] |
3. |
Dilley JD, Gentry WB, Golden KJ. Ketamine infusion as a treatment for major depressive disorder: A new role for anesthesiologists? Middle East J Anaesthesiol 2012;21:871-3. [PUBMED] |
4. |
Diamond PR, Farmery AD, Atkinson S, Haldar J, Williams N, Cowen PJ, et al. Ketamine infusions for treatment resistant depression: A series of 28 patients treated weekly or twice weekly in an ECT clinic. J Psychopharmacol 2014;28:536-44. [PUBMED] |
5. |
Murrough JW, Burdick KE, Levitch CF, Perez AM, Brallier JW, Chang LC, et al. Neurocognitive effects of ketamine and association with antidepressant response in individuals with treatment-resistant depression: A randomized controlled trial. Neuropsychopharmacology 2015;40:1084-90. [PUBMED] |
6. |
ECDD T. Critical Review of KETAMINE; 2006. Available from: http://www.who.int/medicines/areas/quality_safety/4.3Ketamine CritReview.pdf. [Last accessed on 2016 Jul 02]. |
7. |
Hollister GR, Burn JM. Side effects of ketamine in pediatric anesthesia. Anesth Analg 1974;53:264-7. [PUBMED] |
8. |
Weiler MA, Thaker GK, Lahti AC, Tamminga CA. Ketamine effects on eye movements. Neuropsychopharmacology 2000;23:645-53. [PUBMED] |
9. | |
10. |
Quibell R, Prommer EE, Mihalyo M, Twycross R, Wilcock A. Ketamine*. J Pain Symptom Manage 2011;41:640-9. [PUBMED] |
11. |
Kronenberg RH. Ketamine as an analgesic: Parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration. J Pain Palliat Care Pharmacother 2002;16:27-35. [PUBMED] |
12. | |
13. | |
14. | |
15. |
Majidinejad S, Esmailian M, Emadi M. Comparison of intravenous ketamine with morphine in pain relief of long bones fractures: A Double blind randomized clinical trial. Emerg (Tehran) 2014;2:77-80. [PUBMED] |
16. |
Hosseini M, Karami Z, Janzadenh A, Jameie SB, Haji Mashhadi Z, Yousefifard M, et al. The effect of intrathecal administration of muscimol on modulation of neuropathic pain symptoms resulting from spinal cord injury; an experimental study. Emerg (Tehran) 2014;2:151-7. [PUBMED] |
17. | |
18. | |
19. | |
20. | |
21. |
Ramaswamy P, Babl FE, Deasy C, Sharwood LN. Pediatric procedural sedation with ketamine: Time to discharge after intramuscular versus intravenous administration. Acad Emerg Med 2009;16:101-7. [PUBMED] |
22. |
Momeni M, Esfandbod M, Saeedi M, Farnia M, Basirani R, Zebardast J, et al. Comparison of the effect of intravenous ketamine and intramuscular ketamine for orthopedic procedures in children's sedation. Int J Crit Illn Inj Sci 2014;4:191-4. [PUBMED] [Full text] |
23. |
Deasy C, Babl FE. Intravenous vs. intramuscular ketamine for pediatric procedural sedation by emergency medicine specialists: A review. Paediatr Anaesth 2010;20:787-96. [PUBMED] |