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Efficacy of ketamine hydrochloride sedation in children for interventional radiologic procedures
M R Cotsen1, J S Donaldson, T Uejima
1Department of Radiology, Children's Memorial Medical Center, Northwestern University Medical School, Chicago, IL 60614, USA.
Insights
Ketamine hydrochloride provides excellent sedation for pediatric interventional radiology procedures, with high success rates and rapid recovery. This agent is ideal for young patients undergoing short radiologic interventions.
Area of Science:
- Pediatric Anesthesiology
- Interventional Radiology
- Pharmacology
Background:
- Sedation is crucial for pediatric interventional radiology procedures.
- Evaluating effective and safe sedative agents for young children is essential.
Purpose of the Study:
- To assess the efficacy of ketamine hydrochloride for sedation in children under 11 years old undergoing short interventional radiologic procedures.
Main Methods:
- Two hundred eleven children (3 days to 10 years) received ketamine hydrochloride (2 mg/kg IV or 3 mg/kg IM) with atropine sulfate.
- Continuous monitoring of pulse oximetry, blood pressure, respiratory rate, and heart rate.
- Radiologists graded sedation adequacy; induction, procedure, and recovery times were recorded.
Main Results:
- Excellent sedation was achieved in 91% of patients, with procedures completed successfully.
- Average induction times were 45 seconds (IV) and 4 minutes (IM); average recovery was 18 minutes (IV) and 25 minutes (IM).
- Hemoglobin saturation remained above 95% in 94% of patients, with transient desaturations quickly resolving; one infant experienced brief apnea.
Conclusions:
- Ketamine hydrochloride offers excellent sedation and analgesia for pediatric interventional radiology.
- Its rapid induction, quick recovery, and minimal respiratory impact make it suitable for these procedures.
Objective:
The purpose of this study was to evaluate the efficacy of ketamine hydrochloride sedation in children younger than 11 years old who underwent short interventional radiologic procedures.
Subjects And Methods:
Two hundred eleven children, 3 days to 10 years old, were given Ketalar (ketamine hydrochloride; Parke-Davis, Morris Plains, NJ), either 2 mg/kg i.v. (114 patients) or 3 mg/kg intramuscularly (i.m.) (97 patients). Atropine sulfate (Fujisawa USA, Deerfield, IL) (0.01 mg/kg i.v. or 0.02 mg/kg i.m.) was added in all patients to control secretions. Patients were monitored with continuous pulse oximetry and with automatic blood pressure cuffs. Respiratory rate and heart rate were recorded every 5 min. Adequacy of sedation was graded by the radiologist. Induction time, procedure time, recovery time, and adverse effects were recorded.
Results:
Sedation was considered excellent and the procedures were completed in 191 patients (91%). The sedation was considered light but the procedures were completed in the remaining 20 patients (9%). No sedation failures were observed. Average induction time was 45 sec for the i.v. procedure and 4 min for the i.m. procedure. Average recovery time was 18 min for the i.v. procedure and 25 min for the i.m. procedure. Average procedure time for both methods was 25 min. Hemoglobin saturation remained at or greater than 95% in 200 patients (94%). Transient desaturation below 95% occurred in 11 patients (5%). The airway was manipulated to improve ventilation (head, neck, and jaw lifts) and supplemental oxygen was given via nasal cannula or mask. The episodes lasted only a few seconds and oxygen saturation promptly returned to a level greater than 95%. A 7-week-old male infant who had been born prematurely at 32 weeks' gestation experienced apnea. Ventilation was assisted for several breaths and the patient promptly recovered. We observed only minor cardiovascular changes in all patients.
Conclusion:
Ketamine hydrochloride provides excellent sedation and analgesia in young children. The short induction time, rapid recovery, and minimal respiratory depression are features that make this sedative ideal for interventional radiology.