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Repeat Intravenous Ketamine Dosing in Children Undergoing Emergency Department Procedural Sedation
Katherine R Forrester1, Scott M Thomas1, Nita K Gupta2
1Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri.
Insights
Children under 3 years old require the highest ketamine doses during procedural sedation. This study analyzed repeat ketamine dosing frequency and intervals in pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Sedation Management
Background:
- Procedural sedation with intravenous ketamine frequently requires repeat doses for sustained dissociation.
- Limited data exists on the specifics of ketamine dosing intervals and frequencies in pediatric patients.
Purpose of the Study:
- To characterize the frequency, time interval, and dosages of ketamine administered to children during procedural sedation.
- To investigate the influence of patient age and body mass index on ketamine dosing parameters.
Main Methods:
- Retrospective analysis of 419 pediatric patients (1-18 years) who received intravenous ketamine for procedural sedation.
- Data collected from October 2016 to June 2017 in a pediatric emergency department.
- Repeat ketamine dosages were standardized to a 1-hour sedation period.
Main Results:
- 86.6% of patients received at least one repeat ketamine dose, with a median interval of 7 minutes between doses.
- Younger children (<6 years) received higher hourly ketamine doses (mg/kg/h) compared to older children.
- Children under 3 years old received the highest hourly ketamine doses (3.7 mg/kg/h).
- Body mass index did not significantly affect ketamine repeat or hourly dosing.
Conclusions:
- Repeat ketamine dosing is common in pediatric procedural sedation to maintain dissociation.
- Younger children, particularly those under 3 years, require the highest total repeat ketamine dosages.
Background:
Patients undergoing procedural sedation with intravenous ketamine often receive repeat doses to maintain dissociation; however, data between doses are lacking.
Objectives:
The purpose of this study was to characterize the frequency, time interval, and dosages of ketamine received by children undergoing procedural sedation and to explore the effects of age and body mass index on these parameters.
Methods:
This was a retrospective study of patients 1 to 18 years of age undergoing procedural sedation with intravenous ketamine in a pediatric emergency department between October 2016 and June 2017. Total repeat ketamine dosages were standardized to a 1-h sedation.
Results:
Four hundred nineteen patients were included in the analysis. The median sedation time was 33.0 minutes (interquartile range [IQR] 25.0-45.0). Three hundred sixty-three patients (86.6%) received at least 1 repeat ketamine dose. The median time between doses was 7.0 minutes (IQR 5.0-12.0). Children <6 years of age, compared with older children, received higher hourly doses of ketamine in mg/kg/h (2.8 [IQR 1.8-3.9] vs. 1.8 [IQR 1.2-2.6], pc < 0.01). Children <3 years of age, compared with older children, received the highest hourly dose of ketamine in mg/kg/h (3.7 [IQR 2.3-5.0] vs. 1.9 [IQR 1.4-2.8], pc < 0.01). Ketamine repeat and hourly dosing does not appear to be significantly different in children of differing body mass index classes.
Conclusions:
Patients undergoing ketamine sedation often receive repeat doses to maintain dissociation. Patients <3 years of age received the highest total repeat ketamine dosages.
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