Related Experiment Video
Updated: Jan 15, 2026
11:19
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
18.4K
Non-Injectable Ketamine for Pediatric Sedation in the Emergency Department: A Systematic Review
Hadi Mirfazaelian1,2, Alireza Erfan Fazel3, Nima Azizi3
1Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Summary
Non-injectable ketamine (NIK) offers effective procedural sedation and analgesia (PSA) in pediatric emergency departments. Oral ketamine provides desirable sedation with faster onset and shorter duration, and NIK appears safe for PSA in children.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Systematic Review
Background:
- Ketamine is a common medication for procedural sedation and analgesia (PSA) in pediatric emergency departments (ED).
- Pain associated with ketamine injection necessitates exploration of alternative administration routes.
- Non-injectable ketamine (NIK) administration requires further evaluation.
Purpose of the Study:
- To systematically review the details of non-injectable ketamine (NIK) administration for pediatric procedural sedation and analgesia (PSA).
- To evaluate the efficacy and safety of NIK in pediatric patients within the emergency department setting.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched MEDLINE, Embase, Cochrane, Web of Science, and Scopus databases.
- Included original clinical research on NIK for PSA in pediatric populations in the ED; assessed risk of bias and certainty of evidence (COE).
Main Results:
- Twelve studies (1484 patients) were included, primarily evaluating oral ketamine for laceration repair in children aged 2-12 years.
- Oral ketamine (5-10 mg/kg) showed desirable sedation (COE: very low), faster onset (15-35 min), and shorter duration (60-265 min) (COE: low) compared to oral comparators.
- No serious adverse events (SAEs) were reported for oral and nasal ketamine during PSA (COE: moderate to low).
Conclusions:
- Oral ketamine may provide effective sedation with improved onset and duration compared to oral agents for pediatric PSA.
- Non-injectable ketamine (NIK) appears to be safe, with no reported SAEs during procedural sedation and analgesia.
- Limited and heterogeneous studies necessitate further research to confirm findings on NIK efficacy and safety.
More Related Videos
Related Concept Videos
01:24Parenteral Anesthetics: Overview
579
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
579
01:18Drug Delivery: Enteral Route
1.6K
The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
1.6K
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
212
In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
212
01:20Inhalational Anesthetics: Overview
1000
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
1000
01:29Drug Dosing: Infants and Children
253
Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
253
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
192
In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
192