Oral ketamine and midazolam for pediatric burn patients: A prospective, randomized, double-blind study

Purpose: The aim of this study was to compare the efficacy of oral midazolam and ketamine with oral midazolam, acetaminophen, and codeine in providing sedation and analgesia for wound care procedures in children with burns. Methods: This is a prospective, randomized, double-blind study that includes patients 1 to 5 years old hospitalized between 2010 and 2011, with burns covering up to 10% of total body surface area that required bedside wound care. Group 1 received oral midazolam (0.5 mg/kg) and ketamine (5mg/kg). Group 2 received oral midazolam (0.5 mg/kg), acetaminophen (10 mg/kg), and codeine (1 mg/kg). Sedation was assessed using the University of Michigan Sedation Scale and pain using the CHEOPS scale. Results: Sixty patients were enrolled and evenly distributed into the two groups. There were a higher percentage of well-sedated patients in Group 1, but this was not statistically significant. Patients in Group 2 reported lower levels of pain (p=0.0245). Adverse reactions were reported in both groups. The only parameter that had a statistical difference was nystagmus (p=0.001). Conclusion: The combination of oral midazolam and ketamine provides better analgesia than the combination of midazolam, acetaminophen, and codeine for painful procedures in burned children. (C) 2013 Elsevier Inc. All rights reserved.