Ketamine sedation for pediatric procedures: Part 1, a prospective series

Green, Steven M.; Nakamura, Robert M.; Johnson, NE

doi:10.1016/s0196-0644(05)82568-5

Cited by 194 publications

(93 citation statements)

References 36 publications

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“…Not all trials stipulated their atropine dosing; however, those that did roughly adhered to the traditional recommendation 1,41 of 0.01 mg ⁄ kg (regardless of IV or IM), with a minimum of 0.1 mg and a maximum of 0.5 mg. For their trials using glycopyrrolate, Roback et al 26,33 used 5 lg ⁄ kg (regardless of IV or IM) with a maximum of 250 lg. Although these two doses are generally regarded as equipotent, 6,7 it is possible that differences between them may have influenced our results in either direction.…”

Section: Limitationsmentioning

confidence: 99%

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Green

Roback²,

Krauss

2010

Academic Emergency Medicine

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Objectives: Adjunctive anticholinergics are commonly administered during emergency department (ED) ketamine sedation in children under the presumption that drying oral secretions should decrease the likelihood of airway and respiratory adverse events. Pharmacologic considerations suggest that glycopyrrolate might exhibit a superior adverse effect profile to atropine. The authors contrasted the adverse events noted with use of each of these anticholinergics in a large multicenter observational database of ketamine sedations.Methods: This was a secondary analysis of an observational database of 8,282 ED ketamine sedations assembled from 32 prior series. The authors compared the relative incidence of six adverse events (airway and respiratory adverse events, laryngospasm, apnea, emesis, recovery agitation, and clinically important recovery agitation) between children who received coadministered atropine, glycopyrrolate, or no anticholinergic. Multivariable analysis using the specific anticholinergic as a covariate was performed, while controlling for other known predictors.Results: Atropine was associated with less vomiting (5.3%) than either glycopyrrolate (10.7%) or no anticholinergic (11.4%) in both unadjusted and multivariable analyses. Glycopyrrolate was associated with significantly more airway and respiratory adverse events (6.4%) than either atropine (3.3%) or no anticholinergic (3.0%) and similarly more clinically important recovery agitation (2.1% vs. 1.2 and 1.3%). There were, however, no differences noted in odds of laryngospasm and apnea.Conclusions: This secondary analysis unexpectedly found that the coadministered anticholinergic atropine exhibited a superior adverse event profile to glycopyrrolate during ketamine sedation. Any such advantage requires confirmation in a separate trial; however, our data cast doubt on the traditional premise that glycopyrrolate might be superior. Further, neither anticholinergic showed efficacy in decreasing airway and respiratory adverse events.ACADEMIC EMERGENCY MEDICINE 2010; 17:157-162 ª

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Section: Limitationsmentioning

confidence: 99%

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Green

Roback²,

Krauss

2010

Academic Emergency Medicine

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“…Other predetermined analy- ses were correlation of time to discharge with dose, and comparison of mean ketamine doses in children with and without adequate sedation and with and without adverse effects. Statistical tests were 2 , the independent t-test, analysis of variance (ANOVA), the Tukey test, the Pearson correlation, and simple linear regression.…”

Section: Discussionmentioning

confidence: 99%

“…We previously published our ketamine protocol and the sedation characteristics of the 1,022-case study sample. 1,2 In that prospective study, treating physicians completed data forms for 431 of 1,022 sedations (42%) detailing adequacy of sedation and adverse effects. We then reviewed the medical records and data forms (if completed) of all sedation cases using a standardized data abstraction form.…”

Section: Methodsmentioning

confidence: 99%

What Is the Optimal Dose of Intramuscular Ketamine for Pediatric Sedation?

Green

Hummel

Wittlake

et al. 1999

Academic Emergency Medicine

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Abstract. Objective: The optimal dose of IM ketamine for ED procedural sedation in children is not known. The authors wished to quantify the doseresponse of ketamine with respect to sedation adequacy, time to discharge, and adverse effects in order to identify an optimal dose. Methods: The study was a consecutive case series of 1,022 children Յ15 years of age given IM ketamine in the EDs of a university medical center and an affiliated county hospital over a nine-year period. Adequacy of sedation, time to discharge, and adverse effects were compared with dose administered. Results: Doses in the sample averaged 3.96 Ϯ 0.69 mg/kg, with a range of 0.48 to 9.09 mg/ kg. Children judged to be adequately sedated received higher doses compared with those inadequately sedated (3.94 Ϯ 0.44 mg/kg vs 3.77 Ϯ 0.49 mg/kg, p = 0.041), and a nonsignificant trend was noted toward uniformly adequate sedation with increasing dose (Յ91% at <4.00 mg/kg, 93% at 4.00 -4.49 mg/kg, and 100% at Ն4.50 mg/kg). No significant difference or trend in time to discharge or adverse effects was noted between the children receiving <4.00 mg/kg and those receiving Ն4.00 mg/kg of ketamine, and the study had power (␣ = 0.05, ␤ = 0.20) to detect a 9-minute difference in times to discharge, a 3.3% difference in rates of airway complications, a 5.6% difference in rates of emesis, and a 12.3% difference in rates of recovery agitation. Conclusion: Ketamine doses of 4 to 5 mg/kg IM produced adequate sedation in 93% -100% of children, suggesting that this dosing range may be optimal for ED procedural sedation. No difference in time to discharge or adverse effects was observed for lower or higher doses. Key words: ketamine; child; sedation; dissociative state; dosing. ACADEMIC EMER- GENCY MEDICINE 1999; 6:21 -26 T HE DISSOCIATIVE agent ketamine is a safe and effective sedative to facilitate the performance of painful and/or emotionally disturbing ED procedures in children. 1 -8 Despite the fact that the majority of the published experience involves the IM route, the optimal dose for IM ketamine has not been previously established. An ideal dose for ketamine should be sufficiently high to reliably produce adequate sedation conditions while still minimizing the time to discharge and the incidence of adverse effects.We previously reported clinical data from a consecutive case series of 1,022 IM ketamine administrations.1 The protocol at the study institutions recommended a dose of 4 mg/kg. Despite this, the treating physicians frequently chose either higher or lower doses at their discretion, and the data set includes a wide range of initial dosing choices (0.48 to 9.09 mg/kg). We analyzed our 1,022-case experience to test the hypotheses that adequacies of sedation, times to discharge, and the incidences of adverse effects differed by ketamine dose administered. Based upon such results, we then hoped to identify an optimal dose. METHODSStudy Design. This was a retrospective analysis of the database of a prospective case series. The study was approved by the ...

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“…The phencyclidine derivative ketamine has been described as a safe and effective paediatric sedation agent in the developed as well as developing world. 55 Ketamine produces a dissociative state, combination of analgesia, amnesia and sedation at subanaesthetic doses, with minimal effects on the airway and vital reflexes. It is best if combined with an anticholinergic to control secretion and with a benzodiazepine like diazepam to prevent agitation and nightmares.…”

Section: Adverse Events With Sedation In Childrenmentioning

confidence: 99%

Paediatric procedural sedation for radiological imaging

Maruf¹,

Kamal²,

Islam

et al. 2014

j Bangladesh Soc Anaesthesiologists

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Sedation is frequently undertaken for radiological imaging procedures in paediatric patients. Movement during procedure degrades all images of a particular sequence. A deeper level of sedation is needed. The sedation of children is different from the sedation of adult. The safe sedation of children for imaging procedure requires a systematic approach that includes the followings. Careful presedation health evaluation of the child with ASA classification. Appropriate fasting guidelines for sedation procedure. Detailed airway examination for any airway abnormalities that might increase the potential for airway obstruction. Adequate training and skills of sedating personnel in paediatric airway management. Age and size appropriate equipment for airway management and venous access. Adequate medications to combat adverse events. Monitoring of vital parameters during and after the procedure. A properly equipped and staffed recovery area. Recovery to presedation level of consciousness of patient before discharge from medical supervision and appropriate discharge instructions. The whole procedure should be well documented. Children who have contraindications to sedation should be selected for general Anaesthesia. This review article has been made to discuss the need for sedation of children during radiological imaging, currently practiced different regimens of sedation, safe guidelines for sedation and also covers the debate between need for GA versus sedation. DOI: http://dx.doi.org/10.3329/jbsa.v24i2.19805 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(2): 70-76

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Ketamine sedation for pediatric procedures: Part 1, a prospective series

Cited by 194 publications

References 36 publications

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

What Is the Optimal Dose of Intramuscular Ketamine for Pediatric Sedation?

Paediatric procedural sedation for radiological imaging

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