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Ketamine Continuous Infusions in Critically Ill Infants and Children
Charles L Golding1, Jamie L Miller1, Morris R Gessouroun2
1University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA.
The Annals of Pharmacotherapy
|January 20, 2016
Summary
Ketamine continuous infusions (CINs) offer potential benefits for sedation, analgesia, and bronchospasm in critically ill children. Further research is needed to confirm its role as an adjunctive therapy.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Respiratory Medicine
Background:
- Ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, possesses sedative, analgesic, and bronchodilatory properties.
- Its use in critically ill children for various indications is being explored.
Purpose of the Study:
- To review the existing literature on the role of ketamine continuous infusions (CINs) in critically ill children.
- To evaluate its efficacy for sedation, analgesia, withdrawal management, and bronchospasm.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, Cochrane Library) up to December 2015.
- Included were English-language human studies, case reports, and series, totaling 74 patients.
Main Results:
- Ketamine CINs were used for sedation, analgesia, opioid withdrawal, and primarily for refractory bronchospasm in children.
- Dosing varied, with higher doses used for bronchospasm (0.2-3.6 mg/kg/h) compared to sedation/withdrawal (0.24-0.9 mg/kg/h).
- Adverse events were reported in approximately 10.8% of patients, with emergence phenomenon in 4.1%.
Conclusions:
- Limited evidence currently supports ketamine CINs as an adjunctive therapy in critically ill children.
- Further prospective studies are recommended to establish its definitive role in sedation, analgesia, withdrawal, and bronchospasm treatment.
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