Oxygen desaturation in a child receiving a combination of ketamine and midazolam for dental extractions.

A combination of 0.35 mg/kg midazolam and 5 mg/kg ketamine, administered orally for pediatric sedation, resulted in a severe decreases in blood oxygen saturation postoperatively. The patient, a 2-yr-old child, did not respond to command or mild physical stimulation in the recovery room 60 min after receiving the drugs. The benzodiazepine antagonist, flumazenil (0.01 mg/kg), was administered intravenously to reverse the action of midazolam. No adverse effects were observed thereafter, and the postoperative recovery was uneventful. Combining different classes of drugs may result in less variability in patients response, but there is a greater potential for drug-induced side effects and drug interactions.