Feature related to Off-Label use of Ketamine in pediatric anesthesia in Tunisia

抄録

A wide variety of drugs are used in modern anesthetic practice. Some of them are usually used in normal case through a common way such as the intravenous way or the airway. The management of the uncooperative pediatric patient undergoing minor surgical procedures has always been a great challenge. Thus, in pediactric anesthesia we find that rectal way is widely used for several reasons such as its fast action and its acceptance by the child. Usually, an association of three types of drugs are used and complete each other to induce and product the anesthesia : hypnotic drugs, NMBA products and analgesic druds (painkiller). Most common hypnotic drugs are: Barbiturates, Etomidate, Propofol, Midazolam, inhaled gas and the Ketamin. Most of these drugs are administrated by intravenous way or airway except the Midazolam and the ketamin who can be used by rectal administration. Regarding the Midazolam, it's the first water-soluble benzodiazepine that has had widespread accceptance as a parenteral anxiolytic agent and as an anesthetic premedication in both adults and children. Children could be told that their temperature is being taken and frequently they will cooperate for the procedure. Rectal midazolam has been studied as a preanesthetic medication for children and the optimal sedative dose

was determined to be 1.0 mg/kg. However,we find that thrombocytopenia as a reported side effect of Midazolam lead as to use an alternative to Midazolam which is the Ketamine, first derived from phencyclidine and one of the most popular agents for procedural sedation and analgesia in children in the emergency department. Ketamine is usually either injected intramuscularly or insufflated. Additional routes of administration are "plugging" (rectal) and orally. Oral availability of ketamine is poor.The Ketamine is then administrated rectally in Off-Label in pediatric anesthesia. We are all sure of Ketamine's effects on the brain (intracranial pressure), the heart (increase heart rate) and the sleep in addition to hypersalivation and hallucination.

In this paper we are interested in reporting features related to Off-Label use of Ketamine by rectal administration basing on results and observations from cases reported in the National Center for Bone Marrow Transplantation, Tunisia.