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Ketamine and intraocular pressure in children
Shernaz Wadia1, Rahul Bhola2, Douglas Lorenz3
1Division of Pediatric Emergency Medicine, Louisville, KY.
Insights
Ketamine sedation in children may cause a mild, temporary increase in intraocular pressure. Some pediatric patients experienced a transient rise exceeding 5 mm Hg, a level considered potentially significant.
Area of Science:
- Pediatric Emergency Medicine
- Ophthalmology
- Anesthesiology
Background:
- Procedural sedation is common in pediatric emergency departments.
- Ketamine is frequently used for procedural sedation in children.
- The effect of ketamine on intraocular pressure (IOP) in pediatric patients requires further clarification.
Purpose of the Study:
- To determine the increase in intraocular pressure (IOP) during ketamine procedural sedation in children.
- To identify the proportion of children experiencing a clinically significant IOP increase (≥5 mm Hg).
Main Methods:
- Prospective enrollment of 60 children aged 8-18 years undergoing ketamine sedation.
- Measurement of intraocular pressure (IOP) at baseline, immediately post-ketamine, and at 2-minute intervals up to 30 minutes.
- Descriptive analysis of IOP changes.
Main Results:
- The median increase in intraocular pressure (IOP) was 3 mm Hg (range 0-8 mm Hg).
- Fifteen children (25%) exhibited a transient IOP increase of ≥5 mm Hg from baseline.
- The observed IOP elevations were generally mild and transient.
Conclusions:
- Ketamine sedation in children with healthy eyes is associated with mild increases in intraocular pressure.
- Transient IOP increases exceeding 5 mm Hg can occur but are not universal.
- These findings suggest careful monitoring of IOP in pediatric patients receiving ketamine, particularly those with pre-existing ocular conditions.
Study Objective:
We determine the increase in intraocular pressure during pediatric procedural sedation with ketamine, and the proportion of children whose increase might be clinically important (at least 5 mm Hg).
Methods:
We prospectively enrolled children aged 8 to 18 years, chosen to receive ketamine sedation in a pediatric emergency department. We measured intraocular pressure before sedation, immediately after ketamine administration, 2 minutes post-drug administration, and every 5 minutes thereafter until recovery or 30 minutes after the final dose. We descriptively report our observations.
Results:
For the 60 children enrolled, the median intraocular pressure increase was 3 mm Hg (range 0 to 8 mm Hg). Fifteen children had a brief greater than or equal to 5 mm Hg increase in intraocular pressure from baseline.
Conclusion:
In this study of ketamine sedation in children with healthy eyes, we observed mild increases in intraocular pressure that at times transiently exceeded our bounds for potential clinical importance (5 mm Hg).
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