Skip to main content

Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient

Abstract

Patients with impaired ability to understand and communicate can be difficult to manage perioperatively. They frequently require lateral thinking on the part of the anesthesiologists to make the induction process as smooth as possible. We present a case of a severely autistic and violent patient scheduled for dental rehabilitation under general anesthesia. A combination of oral ketamine and midazolam was mixed in the beverage Dr Pepper to mask the taste and the appearance of the drugs. The unique flavor of Dr Pepper is well suited to increase the palatibility and the acceptability of medications in children and patients with developmental delay.

This is a preview of subscription content, access via your institution.

References

  1. Dalton R, Forman MA, Boris NW. Pervasive developmental disorders and childhood psychosis. In: Behrman RE, Kliegman RM, Jensen HB, editors. Nelson textbook of pediatrics. 17th ed. Philadelphia: WB Saunders; 2003. p. 93–95.

    Google Scholar 

  2. Research Units on Pediatric Psychopharmacology Autism Network. Risperidone treatment of autistic disorder: longer-term benefits and blinded discontinuation after 6 months. Am J Psychiatry. 2005;162:1361–1369.

    Article  Google Scholar 

  3. Bachenberg KL. Oral ketamine for the management of combative autistic adult. Anesthesiology. 1998;89:549–550.

    PubMed  Article  CAS  Google Scholar 

  4. Alderson PJ, Lerman J. Oral premedication for paediatric ambulatory anaesthesia: a comparison of midazolam and ketamine. Can J Anaesth. 1994;41:221–226.

    PubMed  CAS  Google Scholar 

  5. Gutstein HB, Johnson KL, Heard MB, Gregory GA. Oral ketamine preanesthetic medication in children. Anesthesiology. 1992;76:28–33.

    PubMed  Article  CAS  Google Scholar 

  6. Turhanoglu S, Kararmaz M, Ozyilmaz S, Tok D. Effects of different doses of oral ketamine for premedication of children. Eur J Anaesthesiol. 2003;20:56–60.

    PubMed  Article  CAS  Google Scholar 

  7. Rainey L, van der Walt JH. The anesthetic management of austistic children. Anaesth Intensive Care. 1998;26:682–686.

    PubMed  CAS  Google Scholar 

  8. Christiansen E, Chambers N. Induction of anesthesia in a combative child; management and issues. Paediatr Anaesth. 2005;15:421–425.

    PubMed  Article  Google Scholar 

  9. Darlong V, Shende D, Subramanyam MS, Sunder R, Naik A. Oral ketamine or midazolam or low dose combination for premedication in children. Anaesth Intensive Care. 2004;32:246–249.

    PubMed  CAS  Google Scholar 

  10. Funk W, Jakob W, Riedl T, Taeger K. Oral preanesthestic medication for children: double-blind randomized study of a combination of midazolam and ketamine vs midazolam or ketamine alone. Br J Anaesth. 2000;84:335–340.

    PubMed  CAS  Google Scholar 

  11. Trabold B, Rzepecki A, Sauer K, Hobbhahn J. A comparison of two different doses of ketamine with midazolam and midazolam alone as oral preanaesthetic medication on recovery after sevoflurane anaesthesia in children. Paediatr Anaesth. 2002;12:690–693.

    PubMed  Article  Google Scholar 

  12. Dagnone D, Matsui D, Rieder MJ. Assessment of the palatability of vehicles for activated charcoal in pediatric volunteers. Pediatr Emerg Care. 2002;18:19–21.

    PubMed  Article  Google Scholar 

  13. Farooqi A, Naqash I, Zargar J, Waqar-ul-Nisa. Midazolam premedication in children: comparison of nasal and sublingual routes. J Anaesth Clin Pharmacol. 2004;20:141–145.

    Google Scholar 

  14. Morton NS. Ketamine for procedural sedation and analgesia in pediatric emergency medicine: a UK perspective. Paediatr Anaesth. 2008;18:25–29.

    PubMed  Google Scholar 

  15. Meyers EF, Muravchick S. Anesthesia induction technics in pediatric patients: a controlled study of behavioral consequences. Anesth Analg. 1977;56:538–542.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

Shah, S., Shah, S., Apuya, J. et al. Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient. J Anesth 23, 126–128 (2009). https://doi.org/10.1007/s00540-008-0685-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-008-0685-4

Key words

  • Premedication
  • Oral ketamine
  • Oral midazolam
  • Autistic patient