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• W1967956057 abstract "S286 INTRODUCTION: This double blind study was performed to find a method for minimizing physical and psychological trauma and to secure the airway during difficult airway management in uncooperative children. Pretreatment with lidocaine spray and ketamine anesthesia was used for laryngeal mask insertion, which can be used as a routine airway as well as a conduit for tracheal intubation [1]. METHODS: After intravenous premedication with midazolam 0.05 mg/kg and glycopyrrolate 0.005 mg/kg, ninety patients were randomly allocated to one of two main groups for the administration of either propofol or ketamine: forty patients received 2.5, 3.0, 3.5 or 4.0 mg/kg of propofol iv (n=10, each), while fifty patients received 2.0, 2.5, 3.0, 3.5 or 4.0 mg/kg of ketamine iv (n=10, each). All of them were allocated by the stratified randomization for age. Only in the ketamine group, was lidocaine spray applied to the oropharynx one min before the induction. So as the physicians involved were blinded to the induction drug, ketamine (50 mg/ml) was diluted to 10 mg/ml with 10% fat emulsion. It thus had the same concentration and the same appearance as a commercial preparation of propofol. Following injection of the designated drug, self-respiration, airway obstruction, and jaw relaxation were checked. Coughing, gagging, swallowing, biting or laryngospasm, secretions, and head or limb movements following LMA insertion were graded. All parameters were respectively graded as satisfactory, acceptable or unsatisfactory. Blood pressure and heart rate were measured just before induction, just before LMA insertion, and one and two minutes after LMA insertion. The overall result was considered satisfactory if all criteria were satisfactory; acceptable if all were better than acceptable, but at least one acceptable criterion was included; unsatisfactory if at least one criterion was unsatisfactory. RESULTS: Overall satisfactory or acceptable results in every patient were achieved only in the ketamine 3.0 or 3.5 mg/kg subgroups. No propofol dose was completely satisfactory; most cases involved apnea or airway obstruction. DISCUSSION: Ketamine anesthesia involving pretreatment with lidocaine spray, and LMA insertion, should be a recognized approach to difficult airway management in children, in whom it is usually considered difficult to expect cooperation." @default.
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• W1967956057 date "1999-02-01" @default.
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• W1967956057 title "LIDOCAINE SPRAY AND KETAMINE FOR LARYNGREAL MASK AIRWAY INSERTION" @default.
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• W1967956057 doi "https://doi.org/10.1097/00000539-199902001-00285" @default.
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