34021
document
Can analysis of the bispectral index prove helpful when monitoring titration of doses of midazolam and ketamine for sedation during paediatric cardiac catheterization . OBJECTIVE We investigated the use of the bispectral index for monitoring sedation during cardiac catheterization . The scores for the bispectral index may not reflect correct values in children , but may be helpful during titration of sedatives such as midazolam and ketamine . METHODS We conducted a prospective randomized clinical trial in 126 patients scheduled for cardiac catheterization in a teaching hospital . They ranged in age from 4 months to 15 years . In 66 patients , sedation was performed without use of the bispectral index , while the index was used in the other 60 patients . The data collected included heart rate , mean arterial pressure , respiratory rate , saturation of oxygen , amount of sedatives , awakening time and adverse effects . We subdivided the patients into age-related groups for each parameter . RESULTS The demographic data were not statistically different . Monitoring with the bispectral index in those aged from 1 to 3 years revealed use of lower doses of midazolam , at 2.09 mg per kg per hr , with standard deviation of 0.36 , and similarly lowers doses of ketamine , at 2.07 mg per kg per hr , with standard deviation of 0.22 , the values in those not monitored being 2.93 , with standard deviation of 0.45 , and 2.96 with standard deviation of 0.51 respectively , these difference being statistically significant ( p = 0.001 and p = 0.04 , respectively ) . In those aged from 3 to 6 years of age , dosage of midazolam was 2.09 , with deviation of 0.36 , and of ketamine 1.78 , with deviation of 0.27 , following use of the bispectral index , compared to 2.89 with deviation of 0.28 , and 2.62 with deviation of 0.69 respectively , when the bispectral index was not used , these again being significant differences ( p = 0.033 and p = 0.04 ) . The requirements for respiratory support and adverse effects were also significantly lower when using the bispectral index ( p less than 0.05 ) . No significant difference was found regarding dosages at the ages of 4 months to 1 year , and 6 to 15 years . The awakening time , however , was shorter with use of the index in those aged from 1 to 6 years . CONCLUSIONS When using the bispectral index for monitoring sedation during catheterization in children , we noted decreased need for doses of midazolam and ketamine , a lower need for respiratory support and less adverse effects .
34022
Intervention_Pharmacological
midazolam
34023
Intervention_Pharmacological
ketamine
34024
Intervention_Physical
bispectral index
34025
Intervention_Pharmacological
midazolam and ketamine
34026
Intervention_Educational
bispectral index
34027
Outcome_Physical
paediatric cardiac catheterization
34028
Outcome_Physical
cardiac catheterization
34029
Outcome_Other
The requirements for respiratory support
34030
Outcome_Adverse-effects
adverse effects
34031
Outcome_Physical
awakening time
34032
Outcome_Other
midazolam
34033
Outcome_Other
ketamine
34034
Outcome_Other
respiratory support
34035
Outcome_Adverse-effects
adverse effects
34036
Participant_Condition
paediatric cardiac catheterization
34037
Participant_Sample-size
126 patients
34038
Participant_Condition
scheduled for cardiac catheterization in a teaching hospital
34039
Participant_Age
They ranged in age from 4 months to 15 years .
34040
Participant_Age
aged from 3 to 6 years of age
34041
Participant_Age
children