Related Experiment Videos
Use of intramuscular ketamine for endoscopy sedation in children
Albert K Law1, Daniel K Ng, Keung-Kit Chan
1Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China.
Insights
Intramuscular ketamine is effective for pediatric endoscopy sedation in children over 7 years old. However, its high failure rate in younger children, especially infants, suggests it should be avoided in this age group.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Pulmonology
Background:
- Sedation is crucial for pediatric endoscopic procedures.
- Intramuscular ketamine offers a potential alternative for procedural sedation.
Purpose of the Study:
- To evaluate the efficacy and safety of intramuscular ketamine for sedation during pediatric endoscopy.
- To determine the success rates of intramuscular ketamine sedation across different age groups in children.
Main Methods:
- Children aged 6 months and older undergoing elective esophagogastroduodenoscopy (EGD), bronchoscopy, or nasopharyngolaryngoscopy (NPL) received intramuscular ketamine (2-3 mg/kg).
- Repeat doses were administered for initial failures; alternative sedation was used for persistent failures.
- Sedation success was defined as completion of the procedure with a single ketamine dose.
Main Results:
- The overall success rate for intramuscular ketamine sedation was 78.3% in 60 children.
- Failure rates were highest in infants (50%) and children aged 1-7 years (32%).
- A significantly lower failure rate (6.7%) was observed in children older than 7 years. Two cases of laryngospasm occurred.
Conclusions:
- Intramuscular ketamine is effective for endoscopy sedation in children over 7 years old.
- Due to high failure rates, intramuscular ketamine should be used cautiously or avoided in children under 7 years.
- Age is a significant factor influencing the success of ketamine sedation in pediatric endoscopy.
Objective:
To report the experience of the use of intramuscular (IM) ketamine for endoscopy sedation in children.
Methodology:
Children over 6 months of age scheduled for elective endoscopy - esophagogastroduodenoscopy (EGD), bronchoscopy and nasopharyngolaryngoscopy (NPL) were enrolled for (2 mg/kg to 3 mg/kg) intramuscular ketamine sedation. A repeated dose of 2 mg/kg intramuscular ketamine was administered to those who failed the first sedation. Alternative sedation (intravenous midazolam and fentanyl) was given to children who failed ketamine sedation twice. Sedation was regarded as successful if the procedure was completed by endoscopist with a single dose of ketamine.
Results:
Sixty children were enrolled for the study. Overall success rate in our patients was 78.3%. Failure rate in infants was 50%, i.e. 4 out of 8. For children aged 1-7, the failure rate was 32%. Failure rate dropped markedly to 6.7% for those older than 7 years of age, and it showed significant difference when compared with the other two groups. Two cases of laryngospasm were experienced in the present study.
Conclusion:
Intramuscular ketamine is an effective medication for sedation in endoscopy undertaken in children over age 7 years, but it should be avoided with children under age 7 because of the high failure rate.