Delayed Effect After Procedural Sedation With Oral Ketamine and Midazolam

In 2025, we reported our experience with the following regimen for pediatric ED procedural sedation: 6 mg/kg oral (PO) ketamine (max 200 mg) and 0.5 mg/kg PO midazolam (max 15 mg). We present 2 children who received this regimen with respiratory depression after apparent recovery. PO ketamine and midazolam may cause a delayed sedative effect, which may limit its usefulness.