Related Experiment Videos
Ketamine sedation for children in the emergency department
S J Priestley1, J Taylor, C M McAdam
1Department of Emergency Medicine, Sunshine Hospital, Melbourne, Victoria, Australia. priests@nwhcn.org.au
Insights
Ketamine provides safe and effective dissociative sedation for children undergoing painful emergency procedures. This protocol ensures rapid onset and good procedural conditions with minimal adverse events.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Sedation Techniques
Background:
- Painful procedures in children within emergency departments often require sedation.
- Existing protocols for ketamine use in pediatric emergency settings vary.
- Developing a standardized protocol is crucial for safe and effective administration.
Purpose of the Study:
- To introduce a novel protocol for dissociative sedation using ketamine in pediatric emergency care.
- To outline the methodology for developing and implementing this sedation protocol.
- To evaluate the efficacy and safety of ketamine for painful procedures in children.
Main Methods:
- A comprehensive literature search and review of international emergency department ketamine protocols.
- Collaborative protocol design involving anesthetic and emergency department nursing staff.
- Administration of ketamine (intramuscular or intravenous) to 28 children aged 1.5-12 years, with adjuncts like midazolam and atropine.
Main Results:
- Rapid onset of sedation (1-7 minutes) was achieved via both intramuscular and intravenous routes.
- Excellent procedural conditions were observed, with an average discharge time of 103 minutes.
- Common side effects included vomiting and rash; one distressing emergence reaction occurred, with no delayed adverse events reported on follow-up.
Conclusions:
- Ketamine is a safe and effective agent for pediatric dissociative sedation during painful emergency procedures.
- Involving anesthetic and emergency department nursing staff in protocol development is key for successful implementation.
- The presented protocol offers a structured approach for ketamine use in children within the emergency department.
Objective:
To introduce a protocol for dissociative sedation using ketamine for children requiring painful procedures within the emergency department.
Method:
A medical literature search was performed along with a review of existing ketamine-use protocols in emergency departments from Australia and the United States. Our hospital anaesthetic department and our emergency department nursing staff were closely involved in protocol design. A series of nursing education sessions were held prior to the drug being used within the emergency department. Twenty-eight children aged 1.5-12 years were administered ketamine sedation prior to undergoing a painful procedure. Ketamine was administered either i.m. (dose 3-4 mg/kg) or i.v. (dose 1.00-2.75 mg/kg) depending on physician preference. Midazolam (dose 0.02 mg/kg) and atropine (dose 0.02 mg/kg) were given as adjuncts in the majority of cases.
Results:
Onset of sedation was rapid (range 1-7 min) for both routes and provided excellent procedural conditions. Discharge time averaged 103 min (range 67-180 min) from time of drug administration. Side-effects included vomiting, rash, diplopia, salivation and one case of a distressing emergence reaction. On telephone follow up 1-3 days after the sedation, no delayed adverse events were reported.
Conclusion:
Ketamine is a safe and effective sedative agent for use in children requiring immobilization to enable performance of a painful procedure. It is important to involve both anaesthetic staff and emergency department nursing staff in sedation protocol development to ensure a smooth introduction. We present a protocol for ketamine use in children undergoing painful procedures within the emergency department.