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.
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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.
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