S‐ketamine and s‐norketamine plasma concentrations after nasal and i.v. administration in anesthetized children

Abstract

Nasal administration of s-ketamine 2 mg x kg(-1) results in a wide spread of plasma concentrations and absorption times. Rapid and high level drug absorption after nasal drug administration is possible. The use of a pulse oximeter and continuous observation after nasal administration of s-ketamine for pediatric premedication is recommended.

187 Intranasal Ketamine for Procedural Sedation and Analgesia in Children: A Systematic Review

“…Onset of sedation in studies reporting this outcome was appreciably longer (11 minutes) than what has been described for IV ketamine (1 minute) [35]. This is consistent with IN ketamine's time to peak plasma concentration of 18 [36] to 21 minutes [37]. Duration of sedation is an outcome important to patients, administrators and clinicians.…”

The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries

“…Other pediatric studies describing intranasal ketamine use have primarily been in the setting of medication before procedures, in which doses were higher (3 to 9 mg/kg). [18][19][20] Ketamine has also been used intranasally in adults with acute pain in the ED. Andolfatto et al 21 described an observational case series in which intranasal ketamine produced a clinically significant reduction in pain for adults presenting to the ED with orthopedic injuries.…”

Ketamine use in current clinical practice

“…Indeed, rapid systemic absorption, combined with the ease of access, makes this route appealing [16] . Overall, there are different doses from different administration routes (Table 1) [9,[16][17][18][19][20] . However, whatever the route chosen, ketamine should be titrated to the required clinical effect.…”

“…However, ketamine can block these mechanisms; when administered at sub-anesthetic and repeated doses, ketamine has been shown to prevent the development of increased pain sensitivity and opioid tolerance [32] . The analgesic effects of ket- By mouth 3−15 mg/kg (children) * [9,18] 500 mg maximum (adults) * [9] Intranasal 0.25−4 mg/kg * [16,19,20] 3−9 mg/kg # [16,19,20] * Analgesa and sedation dose; # Anesthesia dose.…”