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Serious adverse events during procedural sedation with ketamine
Elliot Melendez1, Richard Bachur
1Department of Pediatrics, Division of Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA. elliot.melendez@childrens.harvard.edu
Pediatric Emergency Care
|May 1, 2009
Summary
Intramuscular ketamine increases the risk of respiratory adverse events, including serious events like laryngospasm, compared to intravenous administration. Careful consideration of the administration route is crucial for patient safety during ketamine sedation.
Area of Science:
- Emergency Medicine
- Pediatric Anesthesiology
- Pharmacology
Background:
- Ketamine is widely used for procedural sedation in pediatric emergency departments.
- Understanding the safety profile of different ketamine administration routes is essential for optimizing patient care.
Purpose of the Study:
- To compare the frequency of respiratory adverse events between intramuscular (IM) and intravenous (IV) ketamine administration.
- To identify specific respiratory events and their severity associated with each route.
Main Methods:
- A case-control study was conducted from 1997 to 2005 at a pediatric emergency department.
- Respiratory adverse events included apnea, hypoxemia, hypoventilation, laryngospasm, and airway obstruction.
- Serious adverse events required interventions such as positive pressure ventilation or intubation.
Main Results:
- Out of 4,252 patients, 2.4% experienced respiratory adverse events, with 0.9% being severe.
- Intramuscular ketamine was associated with a higher likelihood of adverse events (OR 2.1).
- Laryngospasm and severe events were significantly more common with IM ketamine administration.
Conclusions:
- Respiratory adverse events are uncommon with ketamine but more frequent with IM administration.
- Serious events, particularly laryngospasm, are rare but carry a higher risk with IM ketamine.
- The increased risk associated with IM ketamine should be factored into sedation planning.
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