Ketamine for procedural pain relief in newborn infants
E Saarenmaaa, P J Neuvonenb, P Huttunenc, V Fellmana
a Hospital for
Children and Adolescents, University of Helsinki, Finland, b Department of
Clinical Pharmacology, University of Helsinki, c Department of Forensic Medicine, University of
Oulu, Finland
Correspondence to: Dr Saarenmaa, Hospital for Children and Adolescents, University of Helsinki, PB 281, 00029 Huch, Finland elina.saarenmaa{at}hus.fi
Accepted 7 February
2001
AIM
To assess the
suitability of ketamine for relief of pain caused by tracheal suction
during ventilator treatment in newborn infants.
STUDY DESIGNIn a
randomised, double blind, cross over trial, 16 newborn infants received
placebo or 0.5, 1, or 2 mg/kg ketamine as two minute infusions in
random order five minutes before four separate endotracheal suctions,
with intervals of at least 12 hours.
RESULTSMean (SD)
plasma ketamine concentration increased linearly with the dose (103 (49), 189 (75), and 379 (97) ng/ml after 0.5, 1, and 2 mg/kg
respectively). Heart rate decreased significantly only after 2 mg/kg
ketamine (
7 (10) beats/min, p = 0.029 v
placebo). The increases in heart rate, arterial blood pressure, and
pain score in response to tracheal suction during the placebo phase (11 (23) beats/min, p = 0.065; 6 (7) mm Hg, p = 0.004; 3.5 (interquartile range (IQR) 2.75-5) points, p = 0.001) were not
attenuated by 0.5 or 2 mg/kg ketamine. However, 1 mg/kg ketamine
attenuated the increase in pain score (1 (IQR 0.75-4.25) points,
p = 0.043 v placebo), but not in heart
rate (7 (23) beats/min) or blood pressure (7 (9) mm Hg).
CONCLUSIONNone of the
doses of ketamine attenuated the changes in heart rate or blood
pressure caused by suction, and only with a dose of 1 mg/kg was the
suction induced pain moderately reduced. Thus infusion of ketamine at
the doses used appears to be an ineffective method of relieving the
pain caused by endotracheal suction.
Keywords: preterm; tracheal suction; ketamine; pain relief
© 2001 by Archives of Disease in Childhood
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- Ketamine for procedural pain in neonates - Risk vs. benefit
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- Fetal Neonatal Ed. Online, 22 Jan 2002 [Full text]
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