Ketamine is a safe, effective, and appropriate technique for emergency department paediatric procedural sedation

Green, S M

doi:10.1136/emj.2004.015370

Cited by 61 publications

(34 citation statements)

References 22 publications

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“…Pediatric PSA with IV ketamine alone is reliably achieved with a dose of 1.5 mg ⁄ kg, while lower doses frequently require repeating. [26][27][28][29][30] It is postulated that by combining ketamine with propofol, clinicians have the ability to provide deep sedation using lower doses of ketamine, which may allow for more rapid recovery. As expected, the median recovery time of 14 minutes documented in this series was longer than most recovery times reported for propofol alone and shorter than those reported for IV ketamine alone.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

Andolfatto

Willman

2010

Academic Emergency Medicine

103

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Objectives: This study evaluated the effectiveness, recovery time, and adverse event profile of intravenous (IV) ketofol (mixed 1:1 ketamine-propofol) for emergency department (ED) procedural sedation and analgesia (PSA) in children.Methods: Prospective data were collected on all PSA events in a trauma-receiving, community teaching hospital over a 3.5-year period, from which data on all patients under 21 years of age were studied. Patients receiving a single-syringe 1:1 mixture of 10 mg ⁄ mL ketamine and 10 mg ⁄ mL propofol (ketofol) were analyzed. Patients received ketofol in titrated aliquots at the discretion of the treating physician. Effectiveness, recovery time, caregiver and patient satisfaction, drug doses, physiologic data, and adverse events were recorded.Results: Ketofol PSA was performed in 219 patients with a median age of 13 years (range = 1 to 20 years; interquartile range [IQR] = 8 to 16 years) for primarily orthopedic procedures. The median dose of medication administered was 0.8 mg ⁄ kg each of ketamine and propofol (range = 0.2 to 3.0 mg ⁄ kg; IQR = 0.7 to 1.0 mg ⁄ kg). Sedation was effective in all patients. Three patients (1.4%; 95% confidence interval [CI] = 0.0% to 3.0%) had airway events requiring intervention, of which one (0.4%; 95% CI = 0.0% to 1.2%) required positive pressure ventilation. Two patients (0.9%; 95% CI = 0.0% to 2.2%) had unpleasant emergence requiring treatment. All other adverse events were minor. Median recovery time was 14 minutes (range = 3 to 41 minutes; IQR = 11 to 18 minutes). Median staff satisfaction was 10 on a 1-to-10 scale.Conclusions: Pediatric PSA using ketofol is highly effective. Recovery times were short; adverse events were few; and patients, caregivers, and staff were highly satisfied.

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Section: Discussionmentioning

confidence: 99%

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

Andolfatto

Willman

2010

Academic Emergency Medicine

103

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“…All previous clinical studies have both established its greater safety (e.g., Green & Krauss, 2004;White, Way, & Trevor, 1982) and failed to detect any long-term impairment as a consequence of its use (e.g., Siegel, 1978). In fact, there is a plethora of recent studies investigating the possibility of damage related to ketamine with normal, pathological (e.g., patients with schizophrenia), and ketamine-abusing volunteers.…”

Section: International Journal Of Transpersonal Studiesmentioning

confidence: 99%

“…neuropathic pain disorder, ischemic limb pain disorder, refractory cancer pain, as an adjunct to standard opioid therapy, and as a pediatric sedation tool for use with acutely injured children (Petrack, Marx, & Wright, 1996;Carr, Goudas, Denman, Brookoff, Staats, Brennen et al, 2004;Ellis, Husain, Saetta, & Walker, 2004;Green & Krauss, 2004;Howes, 2004;McGlone, Howes, & Joshi, 2004;Rakhee & Milap, 2005;Visser & Schug, 2006).…”

Section: International Journal Of Transpersonal Studiesmentioning

confidence: 99%

Ketamine-Enhanced Psychotherapy: Preliminary Clinical Observations on its Effects in Treating Death Anxiety

Kolp¹,

Young²,

Freidman³

et al. 2007

IJTS

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Ketamine, a dissociative anesthetic commonly used by US physicians, has recently been shown to be a powerful anti-depressant and is also capable of eliciting transpersonal experiences that can be transformative. Although currently approved in the US only for use as an anesthetic, physicians there can legally prescribe it off-label to treat various psychological/ psychiatric problems and it has been used for these non-anesthetic purposes in Argentina, Iran, Mexico, Russia, and the UK, as well as in the US. The literature on using ketamine psychotherapeutically is reviewed and two case studies using ketamine-enhanced psychotherapy (KEP) for treating death anxiety in terminally-ill people are reported. The potential importance of beginning formal research on using KEP during end-of-life for those suffering death anxiety is emphasized.

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“…The use of agents with less risk of depressing protective airway reflexes may be preferred. 110 Some emergency patients requiring deep sedation may require protection of the airway before sedation.…”

Section: Before Emergency Sedationmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Coté¹,

Wilson²

2006

Pediatrics

518

150

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision; careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications; appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure; a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction; a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation, as well as an appreciation for drug interactions; appropriate training and skills in airway management to allow rescue of the patient; age-and size-appropriate equipment for airway management and venous access; appropriate medications and reversal agents; sufficient numbers of people to carry out the procedure and monitor the patient; appropriate physiologic monitoring during and after the procedure; a properly equipped and staffed recovery area; recovery to presedation level of consciousness before discharge from medical supervision; and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. INTRODUCTIONInvasive diagnostic and minor surgical procedures on pediatric patients outside the traditional operating room setting have increased in the last decade. As a consequence of this change and the increased awareness of the importance of providing analgesia and anxiolysis, the need for sedation for procedures in physician offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, and ambulatory surgery centers has also markedly increased. In recognition of this need for both elective and emergency use of sedation in nontraditional

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Ketamine is a safe, effective, and appropriate technique for emergency department paediatric procedural sedation

Cited by 61 publications

References 22 publications

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

Ketamine-Enhanced Psychotherapy: Preliminary Clinical Observations on its Effects in Treating Death Anxiety

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

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