Intravenous ketamine sedation for painful oncology procedures

The aim of the study was to determine the efficacy and adverse effects of intravenous (i.v.) ketamine sedation administered by nonanesthetist physicians for painful procedures.

A single-agent, procedural sedation protocol using titrated doses of ketamine i.v. (maximum 2 mg.kg(-1)) was conducted in outpatient pediatric oncology patients undergoing lumbar puncture (LP), bone marrow biopsy/aspiration (BMBx/A) or combination (LP/BMBx/A) in a tertiary care setting. The efficacy of analgesia and sedation (ability to perform the procedure), procedure duration, recovery time and the occurrence of adverse events are described.

Fifty-eight subjects of a median age of 5 years (1-13) and median weight of 20 kg (10.5-68) underwent 119 sedations. An LP was performed in 73% of cases, a BMBx/A in 13% and LP/BMBx/A in 13%. Efficacy was 100% and the mean dose of ketamine was 1.3 mg.kg(-1) (0.4). The mean duration of the procedure was 6.6 min (4.2) and the recovery time was 11 min (4-45). Two subjects (1.7%) had a hypoxemia (SpO2 of <94%). No major airway complications occurred. The prevalence of hypertension (systolic > 20% at 5 min) was 54%. The median pain visual analogue score (VAS) for an observer was 0 (range 0-3) and caregiver was 0 (range 0-4). The median VAS for satisfaction (observer) was 10 (range 7-10) and caregiver VAS was also 10 (range 5-10). At 24 h after discharge, the incidence of bad dreams was 3.3%; vomiting, 10.8%; and abnormal behavior, 4.2%.

Ketamine i.v. up to 2 mg.kg(-1) is an effective sedative for oncology procedures using a defined protocol.