Oral ketamine for pediatric outpatient dental surgery sedation.

This study compared the sedative effectiveness of orally administered ketamine to a combination of oral meperidine/promethazine (Demerol/Phenergan) in two groups of children. One group received ketamine at a dose of 6 mg/kg and the other group received meperidine/promethazine combination at a dose of 2 mg/kg and 0.5 mg/kg, respectively. All children received nitrous oxide 30-50% titrated to effect. A four-point modification of the Houpt et al. rating scale for the overall behavior was used in the evaluations. The quality of sedation, as rated by subjective measurement of overall behavior (sleep, crying, body movement), was higher in the ketamine group (borderline significance; P = 0.07). Mean onset time was significantly shorter (P < 0.001) for ketamine (20.5 min) than meperidine/promethazine (42.4 min) and postoperative sleep time (recovery) was also shorter (borderline significance; P = 0.08) for ketamine (55.6 min) than meperidine/promethazine (106.8 min). Operative times were similar, but the placement of rubber dam and local anesthetic were slightly better tolerated in the ketamine group. Vomiting was significantly more prevalent (P = 0.05) among those who received oral ketamine. Vital signs were consistent for the two groups with no oxygen desaturation below 95%.

Absorption and elimination of midazolam by submucosal and intramuscular routes.

The purpose of this investigation was to compare the rate of absorption and clearance time of midazolam (Versed) when administered by the submucosal (SM) route), and the intramuscular (IM) route in ten healthy adult volunteers, ranging in age from 25 to 35 years. Each subject received midazolam 0.08 mg/kg, to a maximum of 5 mg, by the SM and IM routes at two week intervals. Vital signs and arterial oxygen saturation levels were monitored every five minutes throughout the 180 minute study period. Blood samples (3 ml) were collected via an intravenous line, prior to midazolam administration and at 2, 5, 10, 20, 30, 45, 60, 90, 120, 150 and 180 minutes, centrifuged and analyzed by gas-liquid chromatography. The mean absorption rates and the mean elimination times of the two routes were not significantly different. The mean peak absorption was reached at 10 minutes by the SM route (80.4 ng/ml) and at 20 minutes (92.0 ng/ml) by the IM route, with considerable individual variability. Vital signs were stable throughout the study period in all subjects with both routes. All subjects reported pain at the injection site during SM injection which continued for up to 48 hours. No pain related to the IM injection was reported.