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Changes in blood pressure and heart rate during sedation with ketamine in the pediatric ED

Adam C Patterson1, Shernaz A Wadia1, Douglas J Lorenz2

  • 1Department of Pediatrics, University of Louisville, Louisville, KY.

The American Journal of Emergency Medicine
|December 13, 2016
PubMed

Insights

Ketamine sedation for painful procedures in children causes a modest increase in blood pressure and heart rate. Orthopedic manipulation further elevates blood pressure during this process.

Area of Science:

  • Pediatric Emergency Medicine
  • Pharmacology
  • Cardiovascular Physiology

Background:

  • Ketamine is frequently used for procedural sedation in emergency departments for painful procedures.
  • Changes in blood pressure (BP) and heart rate (HR) during ketamine sedation in children are not well-documented.
  • Understanding these hemodynamic changes is crucial for safe pediatric sedation.

Purpose of the Study:

  • To describe changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) during ketamine procedural sedation in children.
  • To evaluate the impact of orthopedic manipulation on these vital signs.
  • To provide data on the hemodynamic effects of ketamine in a pediatric emergency setting.

Main Methods:

  • Secondary analysis of a prospective, observational study of children aged 8-18 years undergoing ketamine procedural sedation.
  • Serial vital signs and sedation scores were recorded from baseline through recovery.
  • Linear mixed-effect models analyzed changes in SBP, DBP, and HR across sedation states (presedation, sedated, recovery), controlling for age and weight.

Main Results:

  • Mean sedated SBP, DBP, and HR were significantly higher than presedation levels (8 mm Hg, 4 mm Hg, 13 beats/min, respectively; P<.001).
  • Sedated SBP and DBP were also higher than during the recovery phase (3 mm Hg and 4 mm Hg, respectively; P<.01).
  • Orthopedic manipulation led to further increases in mean SBP (5 mm Hg; P<.001) and DBP (7 mm Hg; P<.001).

Conclusions:

  • Ketamine administration for painful procedures results in statistically significant, yet modest, increases in SBP, DBP, and HR in children.
  • Orthopedic manipulation during ketamine sedation further augments blood pressure.
  • These findings contribute to a better understanding of ketamine's hemodynamic effects in pediatric procedural sedation.
Abstract

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