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What is the optimal dose of intramuscular ketamine for pediatric sedation?

S M Green1, C B Hummel, W A Wittlake

  • 1Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, CA, USA. stevegreen@tarascon.com

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|February 3, 1999
PubMed

Insights

For pediatric procedural sedation in the emergency department (ED), intramuscular ketamine doses of 4 to 5 mg/kg appear optimal for achieving adequate sedation. This dosing range demonstrated high efficacy without increasing discharge times or adverse effects in children.

Area of Science:

  • Pediatric Emergency Medicine
  • Pharmacology
  • Sedation and Analgesia

Background:

  • The optimal intramuscular (i.m.) ketamine dosage for procedural sedation in pediatric emergency departments (EDs) remains undetermined.
  • Previous studies have not definitively established a dose-response relationship for ketamine in this setting.

Purpose of the Study:

  • To determine the optimal dose of i.m. ketamine for procedural sedation in children within the ED.
  • To quantify the dose-response relationship concerning sedation adequacy, time to discharge, and adverse events.

Main Methods:

  • A consecutive case series involving 1,022 children (age ≤ 15 years) receiving i.m. ketamine in EDs over nine years.
  • Data collected included ketamine dose administered, sedation adequacy, time to discharge, and adverse effects.
  • Statistical comparisons were made between different ketamine dosage groups.

Main Results:

  • The average ketamine dose administered was 3.96 ± 0.69 mg/kg, with doses ranging from 0.48 to 9.09 mg/kg.
  • Higher ketamine doses correlated with improved sedation adequacy (3.94 ± 0.44 mg/kg for adequate vs. 3.77 ± 0.49 mg/kg for inadequate sedation, p=0.041).
  • A trend towards 100% adequate sedation was observed with doses ≥ 4.50 mg/kg, with no significant differences in discharge time or adverse events across dosage groups.

Conclusions:

  • Intramuscular ketamine doses of 4 to 5 mg/kg are suggested as optimal for pediatric ED procedural sedation, achieving adequate sedation in 93%-100% of cases.
  • This dosage range did not lead to increased discharge times or adverse effects compared to lower or higher doses.
  • Further research may refine optimal ketamine dosing strategies for pediatric procedural sedation.
Abstract

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