Fentanyl-midazolam vs. midazolam-ketamine regarding patient sedation analgesia for emergency orthopedic procedures
DOI:
https://doi.org/10.3329/bjp.v12i2.30381Keywords:
Analgesia, Clinical trial, Emergency Department, Fentanyl, Ketamine, Midazolam, Orthopedic ProcedureAbstract
The aim of the present study was to investigate two pharmaceutical groups including fentanyl-midazolam and midazolam-ketamine used as patient seda-tion analgesia for the orthopedic emergency procedures. This is a prospective randomized double-blind and placebo-controlled trial study. Trauma patients admitted to emergency department who needed emergency reduction were enrolled. Finally 81 patients with mean age of 31.7 ± 20.6 years old were participated (64.2% male). It is likely that the combination of midazolam-ketamine had a better performance in terms of the duration of hypoxia (p=0.01), and pain scores during reduction (p=0.001). However, adverse effects were higher in the midazolam-ketamine group compared to the fentanyl-midazolam. The level of satisfaction of physicians and patients were the same.
Downloads
1846
1704 Read
767
References
Agrawal D, Manzi SF, Gupta R, Krauss B. Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a Pediatric Emergency Department. Ann Emerg Med. 2003; 42: 636-46.
Alimohammadi H, Baratloo A, Abdalvand A, Rouhipour A, Safari S. Effects of pain relief on arterial blood O2 saturation. Trauma Mon. 2014; 19: e14034.
Bailey PL, Pace NL, Ashburn MA, Moll J, East KA, Stanley TH. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990; 73: 826-30.
Baratloo A, Rouhipour A, Forouzanfar MM, Safari S, Amiri M, Negida A. The role of caffeine in pain management: A brief literature review. Anesth Pain Med. 2016; 6: e33193.
Bordo D, Chan S, Shin P. Patient satisfaction and return to daily activities using etomidate procedural sedation for orthopedic injuries. West J Emerg Med. 2008; 9: 86-90.
Cevik E, Bilgic S, Kilic E, Cinar O, Hasman H, Acar AY, Eroglu M. Comparison of ketaminelow-dose midozolam with midazolam-fentanyl for orthopedic emergencies: A double-blind randomized trial. Am J Emerg Med. 2013; 31: 108-13.
Committee ASoA. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: An updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology 2011; 114: 495.
Godambe SA, Elliot V, Matheny D, Pershad J. Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a Pediatric Emergency Department. Pediatrics 2003; 112: 116-23.
Godwin SA, Caro DA, Wolf SJ, Jagoda AS, Charles R, Marett BE, Moore J. Clinical policy: Procedural sedation and analgesia in the Emergency Department. Ann Emerg Med. 2005; 45: 177-96.
Green SM, Krauss B. Pulmonary aspiration risk during Emergency Department Procedural Sedation: An examination of the role of fasting and sedation depth. Acad Emerg Med. 2002; 9: 35-42.
Hostetler MA, Barnard JA. Removal of esophageal foreign bodies in the pediatric ED: Is ketamine an option? Am J Emerg Med. 2002; 20: 96-98.
Jamal S, Fathil S, Nidzwani M, Ismail A, Yatim F. Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation and analgesia in the Emergency Department. Med J Malaysia. 2011; 66: 231-33.
Kennedy RM, Porter FL, Miller JP, Jaffe DM. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics 1998; 102: 956-63.
Migita RT, Klein EJ, Garrison MM. Sedation and analgesia for pediatric fracture reduction in the Emergency Department: A systematic review. Arch Pediatr Adolesc Med. 2006; 160: 46-51.
Miller MA, Levy P, Patel MM. Procedural sedation and analgesia in the Emergency Department: What are the risks? Emerg Med Clin North Am. 2005; 23: 551-72.
Newman DH, Azer MM, Pitetti RD, Singh S. When is a patient safe for discharge after procedural sedation? The timing of adverse effect events in 1,367 pediatric procedural sedations. Ann Emerg Med. 2003; 42: 627-35.
Roback MG, Wathen JE, Bajaj L, Bothner JP. Adverse events associated with procedural sedation and analgesia in a Pediatric Emergency Department: A comparison of common parenteral drugs. Acad Emerg Med. 2005; 12: 508-13.
Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for Emergency Department Sedation in adults: A randomized controlled trial. Ann Emerg Med. 2011; 57: 109-14.
Wathen JE, Roback MG, Mackenzie T, Bothner JP. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, Emergency Department trial. Ann Emerg Med. 2000; 36: 579-88.
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
