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Intravenous ketamine for pediatric sedation in the emergency department: safety profile with 156 cases
S M Green1, S G Rothrock, T Harris
1Department of Emergency Medicine, Loma Linda University School of Medicine, CA, USA. stevegreen@tarascon.com
Insights
Intravenous ketamine is safe for pediatric procedures when administered by emergency physicians under a defined protocol. Both intravenous and intramuscular routes showed comparable safety and sedation.
Area of Science:
- Emergency Medicine
- Pediatric Sedation
- Pharmacology
Background:
- Ketamine is used for procedural sedation in children.
- Intravenous (IV) ketamine administration by emergency physicians (EPs) requires safety assessment.
- Comparison of IV and intramuscular (IM) ketamine sedation characteristics is needed.
Purpose of the Study:
- To evaluate the safety of IV ketamine administered by EPs for pediatric procedures.
- To compare sedation characteristics between IV and IM ketamine routes.
Main Methods:
- Retrospective case series of 156 children (< or =15 years) receiving IV ketamine.
- Data collected on adverse effects, dosing, and procedural outcomes.
- Results compared with existing data on IM ketamine.
Main Results:
- IV ketamine was safely administered for procedures like laceration repair and fracture reduction.
- Adverse events were rare and transient, including single cases of apnea, respiratory depression, emesis, and agitation.
- No cases of laryngospasm or aspiration were reported.
- IV and IM ketamine routes demonstrated comparable safety, sedation efficacy, and time to release.
Conclusions:
- IV ketamine can be safely administered by EPs for pediatric procedures following a specific protocol.
- Sedation characteristics of IV and IM ketamine routes appear to be similar.
Objectives:
To determine the safety of i.v. ketamine when administered by emergency physicians (EPs) for pediatric procedures, and to contrast the sedation characteristics of the i.v. and i.m. routes.
Methods:
The study was a retrospective consecutive case series of children aged < or =15 years given i.v. ketamine in the EDs of a university medical center and an affiliated county hospital over a 9-year period. A protocol for ketamine was used by treating physicians. Records were reviewed for adverse effects, indication, dosing, adjunctive drugs, inadequate sedation, and time to release. Results were contrasted with previously reported data for the i.m. route.
Results:
During the study period i.v. ketamine was administered 156 times, primarily for laceration repair and fracture reduction. Transient apnea and respiratory depression occurred in one patient each; both were quickly identified and were without sequelae. Laryngospasm or aspiration was not noted in any children. There were 6 children with emesis and 2 with mild agitation during recovery. The median time from initial dose to ED release was 103 minutes (25th to 75th percentiles 76 to 146 minutes). The i.v. and i.m. routes were comparable in terms of adverse effects, inadequate sedation, and time to release.
Conclusion:
I.v. ketamine can be administered safely by EPs to facilitate pediatric procedures when used in a defined protocol. The sedation characteristics of the i.v. and i.m. routes appear comparable.