Comparison of Effectiveness and Safety of Ketamine with Midazolam Against Higher Dose of Ketamine as Procedural Sedation for Lumbar Puncture in Children with Leukaemia

Introduction: Children with leukaemia often undergo invasive procedures, requiring sedation to ensure a successful outcome. However, sedatives have devastating side effects. Objective: To compare the effectiveness and safety between combination ketamine and midazolam compared to a higher dose of ketamine as procedure sedative for lumbar puncture (LP) in children with leukaemia. Method: In a double-blind crossover clinical trial, twenty-nine children with leukaemia underwent LP. We compared two regimens: the KM regimen, which combined intravenous midazolam 0.1mg/kg with ketamine 1mg/kg, and the K2 regimen, which used a higher dose of intravenous ketamine, specifically 2mg/kg. The main outcomes were time to achieve the desired sedation, time to complete LP, time to regain consciousness and adverse effects. Results: Twenty-seven patients (93%) were successfully sedated with each of the regimes. In the K2 regimen, the mean time taken for sedation and to be fully conscious after sedation were significantly less (p-value <0.05). Mean time (minute) taken for sedation in K2 regimen and KM regimen were 7.56(SD 4.4) and 8.74(SD 3.6) respectively. Mean time to be fully conscious was 132 minutes (SD 93.5) for K2 regimen and 173 minutes (SD 88.8) for KM regimen. There was no statistically significant difference in mean time taken to complete LP between the 2 regimens (p=0.06). Five patients from either group had desaturation episodes. Eight patients in the KM regimen and seven patients in the K2 regimen required top-up sedation doses. Conclusion: Ketamine is as effective and safe and should be considered in procedural sedation for LP in paediatric leukemic patients.