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 Subject : Uncooperative to Children.. 05/07/2020 02:01:12 PM 
Brian Huang
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Hi,
I wanted to ask instead of mask induction, would ketamine IM be an alternative? I can see some crying and extra secretions at the pre-op area could cause aerosol too. If they are wearing a mask or cloth barrier might help.
Thx
 Subject : Re:Uncooperative to Children.. 05/07/2020 02:33:55 PM 
Steven Butz MD, SAMBA-F
Posts: 7
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I would always argue that IM ketamine is an alternative for an uncooperative child. There is likely sceaming/wrestling for the injection. A mask would help if the pt would wear one, but you should be gowned, eye protected, and masked. The same scenario would be happening with a mask induction. I guess you need to balance where you think the least struggle/contact will occur and how you can best mitigate possible spread.

Indeed a challenge!!

PS, oral ketamine may be better--need a bigger dose and longer time to work, but may be better accepted!
 Subject : Re:Uncooperative to Children.. 05/07/2020 02:52:00 PM 
John Holt
Posts: 1
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The IM route has a big advantage for the provider, but a big disadvantage for turning an uncooperative child into a future cooperative patient. I agree with Steven. Consider the oral route.
 Subject : Re:Uncooperative to Children.. 05/07/2020 03:12:15 PM 
Dr. Audra Webber
Posts: 2
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If you are talking about a todder (2-3 years old) they frequently won't take PO or spit half of it out. If you want a sure bet, go for IM ketamine. Its literally the same as a poke for a vaccination and I explain it to parents as such. Follow it with a shiny cool bandaid and the kid will be mad at you for a minute but they get over it fast. (I'm a pediatric anesthesiologist). Older kids who are cooperative can take a PO versed/ketamine combo.
 Subject : Re:Uncooperative to Children.. 05/07/2020 07:03:02 PM 
Prof. Kumar Belani
Posts: 9
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If you cannot use oral route; nasal route is not a good idea in the presence of COVID; and IM is something you do not want to do then another option is rectal administration via a lubricated feeding tube with the mother laying the child in the lateral position with the upper lower extremity bent at the hip; you may use injectable midazolam alone (same dose as oral) or in combination with ketamine (3mg/kg) - the mixture works very well and is quick; I usually also add atropine (20 mcg/kg) to reduce secretions as this concern has been raised in this discussion.
 
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