Emergency Department Ketamine Sedation: Frequency and Predictors of Critical and High-Risk Adverse Events

We wished to assess the frequency of critical and high-risk adverse events when ketamine is administered for emergency department (ED) procedural sedation in children and to identify clinical predictors of such adverse events.

We studied 20 years of sedation encounters from the Pediatric Sedation Research Consortium registry. We descriptively report the frequencies of critical and high-risk adverse events and evaluate their associations with clinical variables.

Of the 12,780 unique ED ketamine encounters, there were 2 children with critical adverse events (0.016%; 95% confidence interval [CI] 0.0019 to 0.057): 1 occurrence of suspicion for pulmonary aspiration without desaturation, intubation, or unplanned hospitalization, and 1 occurrence of anaphylaxis with unplanned hospitalization. There were 67 children with high-risk events (0.52%; 95% CI 0.41 to 0.66), including 41 occurrences of positive pressure ventilation, 36 of apnea, and 7 of laryngospasm. Predictors of either critical or high-risk adverse events were age more than or equal to 10 years and administered opioids. Higher American Society of Anesthesiologists physical status, upper respiratory infection, and obstructive sleep apnea were not predictive.

In this largest yet study of ketamine as a sole agent for ED pediatric procedural sedation, we found that critical adverse events were rare and high-risk events uncommon. Modest predictors of these events were age more than or equal to 10 years and administered opioids.