Dosing Ketamine for Pediatric Procedural Sedation in the Emergency Department

Background:In this prospective, randomized study, we evaluated the intranasal administration of Midazolam ketamine combination, midazolam, and ketamine in premedication for children.Material and Methods:We studied 60 American Society of Anesthesiology physical status Classes I and II children aged between 1 and 10 years undergoing ear nose throat operations. All cases were premedicated 15 min before operation with intranasal administration of 0.2 mg/kg midazolam in Group M, 5 mg/kg Ketamine in Group K, and 0.1 mg/kg Midazolam + 3 mg/kg ketamine in Group MK. Patients were evaluated for sedation, anxiety scores, respiratory, and hemodynamic effects before premedication, 5 min interval between induction and postoperative period.Results:There was no difference with respect to age, sex, weight, the duration of the operation, and for mask tolerance. Sedation scores were significantly higher in Group MK. There was no statistically difference between the groups for heart rate, oxygen saturation, and respiratory rate.Conclusion:We concluded that intranasal MK combination provides sufficient sedation, comfortable anesthesia induction with postoperative recovery for pediatric premedication.

show abstract

“…Racemic ketamine as a premedicant has been successfully administered through the nasal route. [ 5 9 ]…”

Section: Discussionmentioning

confidence: 99%

The comparison of the efficacy and safety of midazolam, ketamine, and midazolam combined with ketamine administered nasally for premedication in children

2018

View full text Add to dashboard Cite

show abstract

“…To further reduce the risk of adverse events, the potential for medication error was minimized through the use of a standard dosing protocol, with an initial ketamine dose of 2 mg/kg administered strictly over a period of 30 to 60 s. This dose is within the range reported in the pediatric literature, where dosing generally ranges from 1 to 2 mg/kg [ 21 , 22 ]. By standardizing initial dosing at 2 mg/kg for all ages and all procedures and then allowing up-titration in 0.5 mg/kg increments, our protocol both minimized risk of error while allowing for variation in patient responses to sedation, as well as length and type of procedure.…”

Section: Discussionmentioning

confidence: 99%

An innovative safe anesthesia and analgesia package for emergency pediatric procedures and surgeries when no anesthetist is available

et al. 2016

View full text Add to dashboard Cite

BackgroundAdequate pain control through sedation and anesthesia for emergency procedures is a crucial aspect of pediatric emergency care. Resources for administering such anesthesia are extremely limited in many low-income settings.MethodsNon-anesthetist providers in Western Kenya were trained in the use of a ketamine-based sedation and anesthesia package for non-anesthetists, Every Second Matters for Mothers and Babies-Ketamine™ (ESM-Ketamine). Data on use and safety of this package for emergent and urgent pediatric procedures was collected. Providers were surveyed as to what they would have done for similar procedures if the ESM-Ketamine package were unavailable.ResultsNinety procedures were completed for 77 pediatric patients utilizing the ESM-Ketamine package. Of these, 29 (32.2 %) cases were orthopedic reductions, 19 (21.1 %) were incision and drainage, and 19 (21.1 %) were debridement and irrigation of burns. Remaining cases included cesarean section, repair of perineal tear, foreign body removal, arthrocentesis, laceration repair, exploratory laparotomy, excision of mass, paracentesis, and circumcision. There were no serious adverse events in any of the cases, 17 % experienced minor adverse events including hypersalivation, hallucinations, or brief, self-resolving, oxygen desaturations. Providers were surveyed for 80 of the 90 cases as to what they would have done in the absence of the ESM-Ketamine package: in 26 cases (32.5 %), they reported they would proceed with the procedure without any anesthesia or analgesia; in 15 (18.75 %), they reported they would significantly delay the procedure while waiting for an anesthetist; in 13 (16.25 %), they reported they would attempt referral to another facility; and in 26 (32.5 %), they reported they would try using an alternate form of analgesia, primarily acetaminophen, ibuprofen, diclofenac, and/or diazepam. All surveyed providers reported they would use the ESM-Ketamine package again in similar cases.ConclusionsThe ESM-Ketamine package, through the use of a simplified protocol and checklist, allows for safe analgesia and anesthesia in children by non-anesthetists in a resource-limited setting for selected emergent and urgent procedures. This package addresses a significant gap in the availability of anesthesia services in low-income settings that would otherwise result in significant delays to procedures or proceeding with painful procedures with inadequate analgesia.

show abstract

“…The pharmacokinetic modeling of recovery from ketamine sedation by Dallimore suggests that recovery is more rapid when repeated smaller doses are administered instead of a large initial dose that achieves the same length of effective sedation time. 24 …”

Section: Discussionmentioning

confidence: 99%

Rapid Administration Technique of Ketamine for Pediatric Forearm Fracture Reduction: A Dose-Finding Study

Chinta¹,

Schrock²,

McAllister³

et al. 2015

Annals of Emergency Medicine

View full text Add to dashboard Cite

Study Objective To estimate the minimum dose and total sedation time of rapidly infused ketamine that achieves 3-5 minutes of effective sedation in children undergoing forearm fracture reduction in the emergency department. Methods We used the Up-Down method to estimate the median dose of intravenous ketamine infused over ≤ 5 sec that provided effective sedation in 50% (ED50) and 95% (ED95) of healthy children aged 2-5, 6-11 or 12-17 years undergoing forearm fracture reduction. Most were pretreated with opioids. Three investigators blinded to ketamine dose independently graded sedation effectiveness by viewing a video recording of the first 5 minutes of sedation. Recovery was assessed by Modified Aldrete score. Results We enrolled 20 children in each age group. The estimated ED50 was 0.7, 0.5 and 0.6 mg/kg and the estimated ED95 was 0.7, 0.7 and 0.8 mg/kg for the 2-5, 6-11 and 12-17 years age groups, respectively. For the 2-5 years age group, an empirically derived ED95 was 0.8 mg/kg. All who received the empirically derived ED95 in the 2-5 years group or the estimated ED95 in the 6-11 and 12-17 years group had effective sedation. The median total sedation time for the three age groups respectively, was 25, 22.5 and 25 minutes if one dose of ketamine was administered and 35, 25 and 45 minutes if additional doses were administered. No participant experienced serious adverse events. Conclusions We estimated ED50 and ED95 for rapidly infused ketamine for three age groups undergoing fracture reduction. Total sedation time was shorter than most previous studies.

show abstract

Dosing Ketamine for Pediatric Procedural Sedation in the Emergency Department

Cited by 35 publications

References 25 publications

The comparison of the efficacy and safety of midazolam, ketamine, and midazolam combined with ketamine administered nasally for premedication in children

The comparison of the efficacy and safety of midazolam, ketamine, and midazolam combined with ketamine administered nasally for premedication in children

An innovative safe anesthesia and analgesia package for emergency pediatric procedures and surgeries when no anesthetist is available

Rapid Administration Technique of Ketamine for Pediatric Forearm Fracture Reduction: A Dose-Finding Study

Contact Info

Product

Resources

About