Short-acting barbiturate sedation: effect on arterial pH and PaCO2 in children

Premedication for ambulatory surgery in preschool children: a comparison of oral midazolam and rectal thiopentone

Seventy five ASA 1 and 2 children, aged between six months and five years were randomized to receive oral midazolam 0.5 mg.kg-1, rectal thiopentone 35 mg.kg-1 or no premedication to compare the safety and efficacy of, and parental attitudes to, both premedicants. Cardio-respiratory variables were from the time of premedication to awakening from anaesthesia. In addition, anxiety and sedation scores and patients' acceptance of both premedicant and mask at induction, were all recorded using four-point rating scales. Times to recovery and discharge, and parental satisfaction with the premedication their child had received were also recorded. Children receiving rectal thiopentone had higher sedation scores and were more accepting of the mask than were the other two groups (P < 0.001). Their acceptance of the premedication was similar to that of the midazolam group. Times to spontaneous eye opening and discharge were longer in the thiopentone group (P < 0.005). Parental preoperative satisfaction rating was higher for thiopentone, but not midazolam, than no premedication (P < 0.05). When asked their premedication preferences for subsequent general anaesthetics, a higher proportion of parents whose children were not premedicated requested an alternative regimen (P < 0.01). In conclusion the study found that premedication with rectal thiopentone provided superior induction characteristics to oral midazolam, but with a longer recovery period.

Rectal thiopental compared with intramuscular meperidine, promethazine, and chlorpromazine for pediatric sedation

STUDY OBJECTIVES

We studied the hypothesis that rectal thiopental is an effective agent for emergency department pediatric sedation and may have advantages over a more traditional regimen.

DESIGN

Rectal thiopental 25 mg/kg was compared with the combination of meperidine 2 mg/kg, promethazine 1 mg/kg, and chlorpromazine 1 mg/kg in a prospective, randomized, double-blinded study.

TYPE OF PARTICIPANTS

Children between 18 months and 6 years of age presenting to our teaching hospital ED for laceration repair were entered after the clinical decision was made to sedate. Patients with altered sensorium, medical contraindications to sedation, or medication allergy were excluded.

INTERVENTIONS

After informed consent, each patient received IM injection (drug combination or placebo) and rectal suspension (rectal thiopental or placebo) simultaneously.

MEASUREMENTS AND MAIN RESULTS

Vital signs, pulse oximetry, and pediatric Glasgow Coma Scores were recorded before and every 15 minutes after sedation until discharge. Intradermal lidocaine and suturing began when the patient appeared adequately sedated, and response was numerically scored. Patients were discharged when able to stand. Twenty-nine patients 34 +/- 13 months old were studied. Fifteen patients received rectal thiopental, and 14 received the drug combination. Analysis using the Wilcoxon two-sample test revealed no differences in age, sex, weight, or wound location between groups. The time course of sedation was different for the two treatment regimens. At 15 and 30 minutes after administration, patients who received rectal thiopental were more deeply sedated than those who received the drug combination, as evidenced by significantly lower Glasgow Coma Scores (P less than .05). Accordingly, time from medication administration to suturing was 29 +/- 12 minutes in the thiopental group and 54 +/- 33 minutes (P less than .01) in the drug combination group. Patients in the thiopental group also recovered more quickly and were discharged approximately one-half hour earlier than those in the drug combination group (89 +/- 25 vs 120 +/- 44 minutes, P less than .05). No difference in response to lidocaine injection or suturing was demonstrated between the groups. Laceration repair time was comparable between the groups. There were eight sedation failures (three of 15 in thiopental group and five of 14 in drug combination group, P = NS). Vital signs remained stable, no adverse reactions occurred, and no patient had decreased oxygen saturation to less than 95%.

CONCLUSION

Rectal thiopental is superior to this drug combination for pediatric sedation because it can be administered painlessly, has a more rapid onset and offset of action, and is of equal safety and efficacy at the dosage studied.