Efficacy of oral ketamine for providing sedation and analgesia to children requiring laceration repair

Qureshi, Faiqa; Mellis, Peter T.; McFadden, Martin A.

doi:10.1097/00006565-199504000-00009

Cited by 64 publications

(32 citation statements)

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“…These reactions have been shown to be dose dependent. In a few studies, oral ketamine sedation has also been used successfully: for wound care procedures in children with burns,8 for invasive procedures in paediatric oncology patients,9 and for children requiring laceration repair 10. Younge et al 11 compared high oral doses of ketamine (10 mg/kg) with midazolam (0.7 mg/kg) for sedation of children requiring laceration repair.…”

Section: Introductionmentioning

confidence: 99%

“…The optimal oral dosing for ketamine that provides appropriate sedation with minimal or no adverse effects has not been determined yet. Common known adverse effects of ketamine include vomiting, transient ataxia and drowsiness 10 – 13. Oxygen desaturation is a rare complication described only with intravenous or intramuscular delivery 12.…”

Section: Introductionmentioning

confidence: 99%

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A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair

et al. 2013

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair

et al. 2013

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“…Comforting techniques such as parental presence, age-directed preparation and distraction, in combination with topical anaesthesia, can make wound cleansing and closure much less traumatic. [74] Sedation for particularly anxious children can further decrease procedure-related distress [10,[75][76][77] but its benefits may require careful explanation to be accepted by parents. [78] …”

Section: Laceration Repairmentioning

confidence: 99%

“…[77] Mean time from ketamine administration to discharge was 104 minutes. At least 6 mg/kg orally is necessary to induce significant sedation [96] but the optimum oral dose for safe and reliable sedation for ED procedures has yet to be determined and emergence dysphoria can still be problematic.…”

Section: Ketaminementioning

confidence: 99%

Pharmacological Management of Pain and Anxiety During Emergency Procedures in Children

Kennedy

Luhmann

2001

Paediatric Drugs

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Painful procedures are frequently required during treatment of children in the emergency department and are very stressful for the children, their parents and healthcare providers. Pharmacological methods to safely provide almost painless local anaesthesia, analgesia and anxiolysis have been increasingly studied in children. With knowledge of these methods, and patience, the emergency care provider can greatly reduce the distress often associated with emergency care of children. Topical local anaesthetics such as LET [lidocaine (lignocaine), epinephrine (adrenaline), tetracaine] or buffered lidocaine injected through the wound with fine needles can almost painlessly anaesthetise lacerations for suturing. Topical creams such as lidocaine/ prilocaine (EMLA) or tetracaine, iontophoresed lidocaine, or buffered lidocaine subcutaneously injected with fine needles can make intravenous catheter placement virtually 'painless'. When anxiety is significant, and mild to moderate analgesia/ anxiolysis/amnesia is needed, nitrous oxide can be administered if the proper delivery devices are available. Alternatively, when intensely painful fracture reduction, burn debridement, or abscess drainage is necessary, well tolerated and effective deep sedation can be achieved with careful use of midazolam and either ketamine or fentanyl.

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“…It may be given intravenously, intramuscularly, orally or intranasally and has an onset of action of 1 to 2 minutes with a duration of 90 minutes,l43] Adverse effects include hypersalivation, vomiting, emergent reactions, nightmares, laryngospasm, hypertension, tachycardia and increased intracranial pressure. Extensive clinical experience with ketamine has been reported, showing favourable sedation and immobility for brief outpatient procedures,l9, 15,125] Relative contraindications to the use of ketamine include patients whose age is less than 3 months, procedures involving stimulation of the posterior pharynx, active respiratory infection or disease, history of airway instability, head injury or altered mental status, conditions associated with increased intracranial pressure, and glaucoma or acute globe injuryJl25]…”

Section: Ketaminementioning

confidence: 99%

Comparative Review of the Adverse Effects of Sedatives Used in Children Undergoing Outpatient Procedures

D'Agostino

Terndrup

1996

Drug Safety

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Children often fear medical procedures and interventions. Sedative agents enhance the care of these children who undergo outpatient procedures by decreasing anxiety, increasing cooperativity, and providing amnesia. Although higher dosages and intravenous administration of sedatives often produce improved sedation, adverse effects and complications are more frequent. The goals of therapeutic efficacy and safety must be balanced in all patients. The presence or anticipation of anxiety and pain helps in deciding whether to use a sedative alone, or a regimen also providing analgesia. The patient's clinical cardiorespiratory or neurological status, other relative contraindications, the duration of the intended procedure, and the presence or absence of an intravenous line will help in choosing specific drugs. Drug complications are a common cause of adverse events in patients. The combination of a sedative and analgesic, especially a benzodiazepine and an opioid given intravenously, is associated with a higher risk of serious complications. The practitioner responsible for the administration of a sedative to a child must be competent in its use and have the ability to detect and manage complications. Patients who are deeply sedated should be continuously monitored and observed by an individual dedicated to this task. Vital signs and oxygen saturation should be documented at frequent intervals and the patient should be appropriately monitored until discharge criteria have been met. The risk of serious complications with these agents may be reduced with vigorous monitoring and a judicious choice of dosage.

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Efficacy of oral ketamine for providing sedation and analgesia to children requiring laceration repair

Cited by 64 publications

References 0 publications

A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair

A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair

Pharmacological Management of Pain and Anxiety During Emergency Procedures in Children

Comparative Review of the Adverse Effects of Sedatives Used in Children Undergoing Outpatient Procedures

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