Considerations for physicians using ketamine for sedation of children in emergency departments

Abstract

ObjectiveKetamine use in emergency departments (EDs) for procedural sedation and analgesia is becoming increasingly common. However, few studies have examined patient factors related to adverse events associated with ketamine. This study investigated factors for consideration when using ketamine to sedate pediatric ED patients.MethodsThe study included pediatric patients receiving ketamine for laceration repair in the ED. Before sedation, information was collected about upper respiratory tract infection symptoms, allergy history, and fasting time. Patients received 2 mg/kg ketamine intravenously or 4 mg/kg ketamine intramuscularly. The primary outcomes were adverse events due to ketamine.ResultsWe studied 116 patients aged 8 months to 7 years (2.8±1.5 years). The group with adverse events was significantly younger on average than the group without adverse events (2.5±1.5 vs. 3.1±1.5, P=0.028). Upper respiratory tract infection symptoms were not significant variables affecting ketamine sedation (48.9% vs. 43.7%, P=0.719). There was no significant association between duration of fasting and adverse events (P=0.073 and P=0.897, respectively), or between food type and adverse events (P=0.734). However, the number of attempts to sedate and ketamine dose correlated with adverse events (P<0.001 and P=0.022, respectively). In multiple logistic regression analysis, intravenous injection and ketamine dose were significant factors (odds ratio, 16.77; 95% confidence interval, 1.78 to 498.54; odds ratio, 4.37; 95% confidence interval, 1.59 to 22.9, respectively).ConclusionEmergency medicine physicians should consider injection type and ketamine dose when using ketamine sedation while suturing lacerations.

Sedation effects of intranasal dexmedetomidine combined with ketamine and risk factors for sedation failure in young children during transthoracic echocardiography

“…Furthermore, the sedation effects of dexmedetomidine are concentration‐dependent, and the decrease in heart rate caused by dexmedetomidine is also dose‐dependent; therefore, increasing the dose of dexmedetomidine may be accompanied by decreased heart rate . Intranasal ketamine sedation is fast acting in children, but ketamine may lead to high blood pressure, tachycardia, and irritability …”

“…1 Intranasal ketamine sedation is fast acting in children, but ketamine may lead to high blood pressure, tachycardia, and irritability. 2 At our clinical sedation center, we administered dexmedetomidine combined with ketamine intranasally for sedation during transthoracic echocardiography in infants and young children since 2015. In this study, we retrospectively analyzed the clinical data of the infants and young children, and our primary purpose was to evaluate the sedative effects and safety of this two-drug combination;…”

The Difference in Time to Discharge Between Daytime and Nighttime Administration of Ketamine in Children

“…Ketamine, a derivative of phencyclidine, induces dissociative symptoms by stimulating the limbic system and inhibiting the cerebral cortex. [11][12][13] Circadian rhythm determines daily cycles including sleep patterns and is also a role of the hypothalamus in the limbic system via suprachiasmatic nuclei. 24,25 Animal model studies about the correlation between ketamine and circadian rhythm have shown that ketamine affects the phase shifts of the circadian rhythm.…”

“…For these reasons, the Pediatric Emergency Medicine Committee of the American College of Emergency Physicians strongly recommends the proper use of analgesics and sedatives for children in the ED. 4,5 Ketamine is the most popular, effective, and safe sedative for emergency procedures in children, [6][7][8][9][10][11][12][13] and it is known that ketamine has an effect on circadian rhythm. 14,15 Therefore, clinicians have thought and communicated to children's guardians that time to discharge might be longer when injected at nighttime than in the daytime, and with the same dosage.…”

“…Ketamine is the most popular, effective, and safe sedative for emergency procedures in children, 6–13 and it is known that ketamine has an effect on circadian rhythm 14,15 . Therefore, clinicians have thought and communicated to children's guardians that time to discharge might be longer when injected at nighttime than in the daytime, and with the same dosage.…”