865 Intranasal Midazolam and Ketamine for Gastric Aspirates in Children Evaluated for Suspected Tuberculosis

Abstract

Background and Aims To confirm the diagnosis of pulmonary tuberculosis in children sequential gastric lavages are recommended. Limitations of gastric lavage include the need for an overnight fast, repeated specimens, and low sensitivity. Moreover, the procedure is very unpleasant for children, parents, and health workers; so sedation may be recommended. We evaluate the safety and efficacy of intranasal administration of midazolam and ketamine in uncooperative children undergoing gastric aspirates to diagnose pulmonary tuberculosis. Methods We studied 11 children with suspected tuberculosis. Gastric lavages were done on three consecutive days after intranasal administration of midazolam (0.5 mg/kg) and ketamine (2 mg/kg) by a mucosal atomizer device. Pain score was assessed by the MOPS score, ranging from 0 to 10 (the higher the score the greater the pain experienced for the child). Gastric specimens underwent polymerase chain reaction for Mycobacterium tuberculosis and were stained for acid-fast bacilli. Results We performed 33 procedures. Median age of children was 56.4 months (13-360). 10 children were diagnosed with pulmonary tuberculosis and another 1 with latent tuberculosis. Mean MOPS score was 4 (range 2-8). The degree of sedation achieved enabled all procedures to be completed without requiring additional drugs. The only side effect registered was transitory euphoria in 6 cases (18%). Sedation was always well accepted by both parents and health workers. Conclusions This study has shown that the combined use of intranasal Midazolam and Ketamine appears to be a safe and effective method to achieve children's short-term sedation and to facilitate the gastric lavage procedures.