Ketamine sedation for pediatric critical care procedures

Area of Science:

• Pediatric Critical Care Medicine
• Anesthesiology
• Pharmacology

Background:

• Procedural sedation is essential in pediatric intensive care units (PICUs).
• Ketamine offers unique properties for sedation, including bronchodilation and analgesic effects.
• Limited data exists on ketamine's safety and efficacy for diverse procedures in critically ill children.

Purpose of the Study:

• To evaluate the experience and safety profile of ketamine for procedural sedation in a PICU.
• To document indications, dosing, and adverse events associated with ketamine use.
• To assess the effectiveness of ketamine in facilitating critical care procedures.

Main Methods:

• Retrospective case series of children receiving ketamine for procedural sedation over five years.
• Data collected included procedure type, ketamine dosage, adverse events, sedation adequacy, and recovery time.
• Patient records were reviewed for 442 sedation instances.

Main Results:

• Ketamine was used for 442 procedures, including central line placement, esophagogastroduodenoscopy, and wound debridement.
• Most patients had significant comorbidities (ASA class ≥3 in 88%).
• Adverse effects were infrequent and generally mild, with no ketamine-attributable adverse outcomes.

Conclusions:

• Skilled pediatric intensivists can safely and effectively administer ketamine for procedural sedation.
• Ketamine is a viable option for sedating critically ill children undergoing procedures.
• The drug demonstrated a favorable safety profile even in a complex patient population.