Table 3

Ketamine or midazolam: does it mater which?

StudyStudy groupStudy type (level of evidence)OutcomeKey resultsComments
Younge and Kendall459 Children aged 1–7 years with lacerations requiring LA injection or topical application+anxiety score >1 followed by suturing. Received either IV midazolam or IV ketamineRandomised, double blinded trial (level 1)Anxiety/tolerance score (4=uncontrolled crying, 1=co-operative)Ketamine vs midazolam=2 vs 1 (medians); p=0.0029No power calculation performed as non-continuous ordinal scale. No 95% CI given. Acknowledges larger study needed
Sedation score (5=agitated, 1=barely rousable)Ketamine vs midazolam=2 vs 3 (medians); p=0.039
Time to sedation score of <4Ketamine vs midazolam=20 vs 43 min (medians); p=0.001
Time to dischargeKetamine vs midazolam=105 vs 110 min
McGlone et al587 Children aged 1–7 years with wounds needing suturing. Received either IM ketamine or IM midazolam with or without IN flumazenilProspective comparative study (level 2)RestraintKetamine vs midazolam: three body parts held, 2 vs 6; 0 body parts held, 27 vs 2; p=0.0001No blinding. Active selection by doctors' assessment of combative behaviours into the ketamine group, although this strengthens ketamine results. No 95% CI given
AgitationKetamine vs midazolam: uncontrolled crying 2% vs 10%; co-operative 83% vs 42%; p=0.001
Time to dischargeKetamine vs midazolam=102 vs 95 min
McGlone et al6102 Children aged 1–7 years with simple wounds needing suturing. Received either IM ketamine or IN midazolamProspective comparative study (level 2)Oxygen saturationMedian SpO2 97% in both groupsNo blinding. Text unclear as to place of p values quoted. No 95% CI given
Restraint measured by restraint score (score 3=3 body parts held, score 0=no body parts held)Ketamine vs midazolam: score 3=3 vs 15; score 0=41 vs 7
Agitation measured by agitation score (score 3=agitated, score 0=quiet)Ketamine vs midazolam: score 3 1 vs 3; score 0=34 vs 31
Time to dischargeMidazolam vs ketamine=75 vs 82 min
Acworth et al753 Children aged 6 months to 12 years requiring minor procedures, received either IN midazolam or combination IV ketamine and midazolamSingle blinded randomised trial (level 1)Degree of sedation on sedation score (score 5=agitated, 1=unconscious)Mean score ketamine vs midazolam=2.5 vs 3.5; p=0.001Well performed and written study. Two children in IN group inadequately sedated
Time to sedationKetamine vs midazolam=2 vs 7.31 min (95% CI 3.2 to 7.4)
Time to dischargeKetamine vs midazolam=97.9 vs 79 min; p=0.02
  • IM, intramuscular; IN, intranasal; IV, intravenous; LA, local anaesthesia.