Related Experiment Video
Updated: Feb 16, 2026
Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
Considerations for physicians using ketamine for sedation of children in emergency departments
Woo Sung Kim1, Ji Yeon Ku1, Hanbyul Choi2
1Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Insights
Younger pediatric patients receiving ketamine for procedural sedation in the emergency department experienced more adverse events. Intravenous administration and higher ketamine doses were significant factors associated with these events.
Area of Science:
- Emergency Medicine
- Pediatric Sedation
- Pharmacology
Background:
- Ketamine is increasingly used for procedural sedation and analgesia in emergency departments (EDs).
- Limited research exists on patient-specific factors influencing adverse events in pediatric ketamine sedation.
- This study addresses the need to identify factors for safe ketamine use in children within the ED setting.
Purpose of the Study:
- To investigate patient factors associated with adverse events in pediatric patients undergoing ketamine sedation for laceration repair in the ED.
- To identify key variables that emergency medicine physicians should consider to optimize ketamine administration in children.
Main Methods:
- A cohort of 116 pediatric patients (8 months to 7 years) receiving ketamine for ED laceration repair was studied.
- Data collected included age, upper respiratory tract infection symptoms, allergy history, and fasting status.
- Ketamine was administered intravenously (2 mg/kg) or intramuscularly (4 mg/kg), with adverse events as the primary outcome.
Main Results:
- Younger patients (mean age 2.5 years) were significantly more likely to experience adverse events compared to older patients (mean age 3.1 years).
- Higher ketamine doses and intravenous administration were significantly correlated with adverse events.
- Factors such as upper respiratory tract infection symptoms, fasting duration, and food type were not significant predictors of adverse events.
Conclusions:
- Emergency medicine physicians should carefully consider ketamine dose and injection route (intravenous vs. intramuscular) when sedating pediatric patients for laceration repair.
- Younger age is a significant factor associated with increased risk of adverse events during ketamine sedation.
- Further research may explore optimal dosing and administration strategies to minimize adverse events in pediatric procedural sedation.
Objective:
Ketamine use in emergency departments (EDs) for procedural sedation and analgesia is becoming increasingly common. However, few studies have examined patient factors related to adverse events associated with ketamine. This study investigated factors for consideration when using ketamine to sedate pediatric ED patients.
Methods:
The study included pediatric patients receiving ketamine for laceration repair in the ED. Before sedation, information was collected about upper respiratory tract infection symptoms, allergy history, and fasting time. Patients received 2 mg/kg ketamine intravenously or 4 mg/kg ketamine intramuscularly. The primary outcomes were adverse events due to ketamine.
Results:
We studied 116 patients aged 8 months to 7 years (2.8±1.5 years). The group with adverse events was significantly younger on average than the group without adverse events (2.5±1.5 vs. 3.1±1.5, P=0.028). Upper respiratory tract infection symptoms were not significant variables affecting ketamine sedation (48.9% vs. 43.7%, P=0.719). There was no significant association between duration of fasting and adverse events (P=0.073 and P=0.897, respectively), or between food type and adverse events (P=0.734). However, the number of attempts to sedate and ketamine dose correlated with adverse events (P<0.001 and P=0.022, respectively). In multiple logistic regression analysis, intravenous injection and ketamine dose were significant factors (odds ratio, 16.77; 95% confidence interval, 1.78 to 498.54; odds ratio, 4.37; 95% confidence interval, 1.59 to 22.9, respectively).
Conclusion:
Emergency medicine physicians should consider injection type and ketamine dose when using ketamine sedation while suturing lacerations.
Related Concept Videos
01:27Emerging Adulthood
01:23Sedatives and Hypnotics: Overview
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
01:20Sedatives and Hypnotics Drugs: Barbiturates
01:19Sedatives and Hypnotics Drugs: Benzodiazepines
Benzodiazepines work by enhancing the effects of the inhibitory neurotransmitter GABA. They bind to the GABAA receptor, increasing its affinity for GABA, which opens chloride...
01:22Design Consideration
The factor of safety is another key...
01:17Sedatives and Hypnotics Drugs: Miscellaneous Agents
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...