Midazolam smoothens adult ketamine sedation

March 6, 2011 by  
Filed under All Updates, Resus

In adults undergoing procedural sedation with ketamine, 0.03 mg/kg IV midazolam reduced recovery agitation compared with placebo.

You don't need this. Just give the midazolam.

STUDY OBJECTIVE: We assess whether midazolam reduces recovery agitation after ketamine administration in adult emergency department (ED) patients and also compared the incidence of adverse events (recovery agitation, respiratory, and nausea/vomiting) by the intravenous (IV) versus intramuscular (IM) route.

METHODS: This prospective, double-blind, placebo-controlled, 2×2 factorial trial randomized consecutive ED patients aged 18 to 50 years to 4 groups: receiving either 0.03 mg/kg IV midazolam or placebo, and with ketamine administered either 1.5 mg/kg IV or 4 mg/kg IM. Adverse events and sedation characteristics were recorded.

RESULTS: Of the 182 subjects, recovery agitation was less common in the midazolam cohorts (8% versus 25%; difference 17%; 95% confidence interval [CI] 6% to 28%; number needed to treat 6). When IV versus IM routes were compared, the incidences of adverse events were similar (recovery agitation 13% versus 17%, difference 4%, 95% CI -8% to 16%; respiratory events 0% versus 0%, difference 0%, 95% CI -2% to 2%; nausea/vomiting 28% versus 34%, difference 6%, 95% CI -8% to 20%).

CONCLUSION: Coadministered midazolam significantly reduces the incidence of recovery agitation after ketamine procedural sedation and analgesia in ED adults (number needed to treat 6). Adverse events occur at similar frequency by the IV or IM routes.

Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial
Ann Emerg Med. 2011 Feb;57(2):109-114

Comments

One Response to “Midazolam smoothens adult ketamine sedation”

  1. The LITFL Review 009 - Life in the FastLane Medical Blog on March 7th, 2011 06:45

    [...] Midazolam smoothens adult ketamine sedation — a recent RCT in the ever popular Annals of Emergency Medicine gives an NNT of 6 for preventing recovery agitation when midazolam 0.3 mg/kg IV is coadministered with ketamine for procedural sedation in adults. [...]