Electronic Letters to:

: Ray McGlone, Trevor Fleet, Stuart Durham, and Sally Hollis A comparison of intramuscular ketamine with high dose intramuscular midazolam with and without intranasal flumazenil in children prior to suturing clinmed/1999120007v2 [Abstract] [Full text]

Electronic letters published:

Sedation or Analgesia?

James E. Brown, MD   (31 January 2001)

Sedation or Analgesia? 31 January 2001
James E. Brown, MD, Anesthesiologist Memorial Mission Hospital, Asheville, NC, USA Send letter to journal: Re: Sedation or Analgesia? jambro{at}home.com James E. Brown, MD	I am not surprised by your findings. As an anesthesiologist I have been impressed by the fact that, try as one might, analgesia must be provided in the performance of any procedure done with local anesthesia. Midazolam in any dosage, is not an analgesic. Ketamine is. I have long held the view that the combination of pain and sedation leads to increased agitation, requiring more and more sedation until a general anesthetic effectively ensues. Simply adding an analgesic such as intranasal fentanyl, sufentanyl, or ketamine, alone or in combination with lower doses of midazolam results in a smoother procedure and happier patient. If amnesia for the procedure is the only desired outcome, midazolam and physical restraints can do that, but physiologic responses are not controlled. I was amused by your use of the term "Brutacaine." In the US we have a similar term "Cyclobrutane" which means to "surround him and hold him down." -- James E. Brown,MD