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Ketamine-associated vomiting: is it dose-related?
Andrea W Thorp1, Lance Brown, Steven M Green
1Division of Pediatric Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA 92354, USA. athorp@llu.edu
Pediatric Emergency Care
|January 1, 2009
Summary
Ketamine sedation in children rarely causes vomiting, and it is not linked to initial or total doses, except for a slight increase with very high cumulative doses.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Clinical Toxicology
Background:
- Vomiting is a frequent side effect of ketamine sedation in pediatric emergency departments.
- Understanding dose-related risks is crucial for safe ketamine administration.
Purpose of the Study:
- To investigate the relationship between intravenous ketamine dosage and the incidence of vomiting in children undergoing procedural sedation.
- To determine if initial or total ketamine doses correlate with vomiting rates.
Main Methods:
- Prospective observational study of 1039 pediatric patients receiving intravenous ketamine for sedation.
- Physicians administered ketamine at their discretion; doses were compared between children with and without vomiting.
- Logistic regression analysis controlled for age and coadministered drugs.
Main Results:
- Vomiting occurred in 7% of sedations.
- No significant association was found between initial ketamine dose and vomiting.
- A modest increase in vomiting was observed only in the small subset of children receiving high cumulative doses (>7 mg/kg).
Conclusions:
- Ketamine-induced vomiting in children is generally not dose-dependent within a broad range of administration.
- High cumulative ketamine doses (>7 mg/kg) may be associated with a slightly elevated risk of emesis.
- Current dosing strategies appear safe regarding vomiting as a primary adverse event.
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