Haemodynamic effects of ketamine in the paediatric cardiac intensive care unit: insights from high-fidelity...

There has been a growing clinical application of ketamine for procedural sedation. This study aimed to determine its hemodynamic effects when utilized in patients in the pediatric cardiac intensive care unit.

In this single-center, retrospective study, patients who were admitted to the pediatric cardiac intensive care unit and received a single dose of intravenous ketamine were studied. Patients were monitored utilizing high-fidelity physiologic data. Variables of interest for the study included: heart rate, arterial saturation, respiratory rate, mean arterial blood pressure, central venous pressure, and renal near infrared spectroscopy These variables of interest were obtained 30 min prior to the administration of ketamine, through 30 min after, serving as the comparison arm. Secondary aims included unexpected apnea, need for a fluid bolus, vasoactive bolus, or cardiopulmonary resuscitation.

A total of 45 administrations of intravenous ketamine were included. Average dose was 0.8 mg/kg per dose. Average age was 8.1 months. After administration of ketamine, there was a statistically significant increase in heart rate, arterial saturation, renal near infrared spectroscopy and central venous pressure and a statistically significant decrease in respiratory rate and mean arterial blood pressure. No cardiopulmonary resuscitation or bolus vasoactive was required after ketamine administration.

Intravenous ketamine dosed from 0.5 mg/kg to 1 mg/kg per dose in the pediatric cardiac intensive care unit appears safe and is associated with minimal hemodynamic change, apnea, or hemodynamic collapse. This represents the first data related to a single dose of ketamine's effect captured with a 1-s temporal resolution.