Skip to main content
Anesthesia Progress logoLink to Anesthesia Progress
. 1997 Spring;44(2):68–70.

Oxygen desaturation in a child receiving a combination of ketamine and midazolam for dental extractions.

J A Roelofse 1, P G Roelofse 1
PMCID: PMC2148828  PMID: 9481964

Abstract

A combination of 0.35 mg/kg midazolam and 5 mg/kg ketamine, administered orally for pediatric sedation, resulted in a severe decreases in blood oxygen saturation postoperatively. The patient, a 2-yr-old child, did not respond to command or mild physical stimulation in the recovery room 60 min after receiving the drugs. The benzodiazepine antagonist, flumazenil (0.01 mg/kg), was administered intravenously to reverse the action of midazolam. No adverse effects were observed thereafter, and the postoperative recovery was uneventful. Combining different classes of drugs may result in less variability in patients response, but there is a greater potential for drug-induced side effects and drug interactions.

Full text

PDF
68

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bennett C. R. Conscious sedation: an alternative to general anesthesia. J Dent Res. 1984 Jun;63(6):832–833. doi: 10.1177/00220345840630060201. [DOI] [PubMed] [Google Scholar]
  2. Collins S., Carter J. A. Resedation after bolus administration of midazolam to an infant and its reversal by flumazenil. Anaesthesia. 1991 Jun;46(6):471–472. doi: 10.1111/j.1365-2044.1991.tb11687.x. [DOI] [PubMed] [Google Scholar]
  3. Duncan W. K., Pruhs R. J., Ashrafi M. H., Post A. C. Chloral hydrate and other drugs used in sedating young children: a survey of American Academy of Pedodontics Diplomates. Pediatr Dent. 1983 Dec;5(4):252–256. [PubMed] [Google Scholar]
  4. Green S. M., Johnson N. E. Ketamine sedation for pediatric procedures: Part 2, Review and implications. Ann Emerg Med. 1990 Sep;19(9):1033–1046. doi: 10.1016/s0196-0644(05)82569-7. [DOI] [PubMed] [Google Scholar]
  5. Hawk W., Crockett R. K., Ochsenschlager D. W., Klein B. L. Conscious sedation of the pediatric patient for suturing: a survey. Pediatr Emerg Care. 1990 Jun;6(2):84–88. doi: 10.1097/00006565-199006000-00003. [DOI] [PubMed] [Google Scholar]
  6. Kissin I., Brown P. T., Bradley E. L., Jr Sedative and hypnotic midazolam-morphine interactions in rats. Anesth Analg. 1990 Aug;71(2):137–143. doi: 10.1213/00000539-199008000-00005. [DOI] [PubMed] [Google Scholar]
  7. Kupietzky A., Houpt M. I. Midazolam: a review of its use for conscious sedation of children. Pediatr Dent. 1993 Jul-Aug;15(4):237–241. [PubMed] [Google Scholar]
  8. Roelofse J. A., Joubert J. J., Roelofse P. G. A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. J Oral Maxillofac Surg. 1996 Jul;54(7):838–846. doi: 10.1016/s0278-2391(96)90531-5. [DOI] [PubMed] [Google Scholar]
  9. Roelofse J. A., Joubert J. J., Swart L. C., Stander I., Roelofse P. G. An evaluation of the effect of oral ketamine and standard oral premedication in the sedation of paediatric dental patients. J Dent Assoc S Afr. 1996 Apr;51(4):197–201. [PubMed] [Google Scholar]
  10. Roelofse J. A., van der Bijl P., Stegmann D. H., Hartshorne J. E. Preanesthetic medication with rectal midazolam in children undergoing dental extractions. J Oral Maxillofac Surg. 1990 Aug;48(8):791–797. doi: 10.1016/0278-2391(90)90333-w. [DOI] [PubMed] [Google Scholar]
  11. Tverskoy M., Fleyshman G., Bradley E. L., Jr, Kissin I. Midazolam-thiopental anesthetic interaction in patients. Anesth Analg. 1988 Apr;67(4):342–345. [PubMed] [Google Scholar]
  12. Warner D. L., Cabaret J., Velling D. Ketamine plus midazolam, a most effective paediatric oral premedicant. Paediatr Anaesth. 1995;5(5):293–295. doi: 10.1111/j.1460-9592.1995.tb00307.x. [DOI] [PubMed] [Google Scholar]
  13. Wilson E., David A., MacKenzie N., Grant I. S. Sedation during spinal anaesthesia: comparison of propofol and midazolam. Br J Anaesth. 1990 Jan;64(1):48–52. doi: 10.1093/bja/64.1.48. [DOI] [PubMed] [Google Scholar]
  14. van der Bijl P., Roelofse J. A. Disinhibitory reactions to benzodiazepines: a review. J Oral Maxillofac Surg. 1991 May;49(5):519–523. doi: 10.1016/0278-2391(91)90180-t. [DOI] [PubMed] [Google Scholar]
  15. van der Bijl P., Roelofse J. A., Stander I. A. Rectal ketamine and midazolam for premedication in pediatric dentistry. J Oral Maxillofac Surg. 1991 Oct;49(10):1050–1054. doi: 10.1016/0278-2391(91)90136-a. [DOI] [PubMed] [Google Scholar]

Articles from Anesthesia Progress are provided here courtesy of American Dental Society of Anesthesiology

RESOURCES