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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
PubMed

Insights

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.
Abstract

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