The Lancaster experience of 2.0 to 2.5 mg/kg intramuscular ketamine for paediatric sedation: 501 cases and analysis

McGlone, R; Howes, Marten; Joshi, M.

doi:10.1136/emj.2002.003772

Cited by 75 publications

(49 citation statements)

References 30 publications

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“…(23,24) Our findings were similar to these studies, in that the initial dose of IM ketamine administered (3 kg/mg or 4 kg/mg) did not predispose the patient to emesis.…”

Section: Discussionsupporting

confidence: 80%

Predictors of emesis in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

Suryaprakash

Tham

2017

smedj

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“…(23,24) Our findings were similar to these studies, in that the initial dose of IM ketamine administered (3 kg/mg or 4 kg/mg) did not predispose the patient to emesis.…”

Section: Discussionsupporting

confidence: 80%

Predictors of emesis in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

Suryaprakash

Tham

2017

smedj

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“…Numerous studies and randomized controlled trials (RCTs) on the use of ketamine show a favorable safety profile, with a low risk of airway complications and emergence phenomena. [1][2][3][4][5][6][7][8][9][10] One of the key disadvantages of ketamine, however, is the long recovery period. The optimal parenteral mode of ketamine administration-intravenous (IV) versus intramuscular (IM)-has been discussed in only a small number of studies and reviews in terms of time to discharge and its relationship to the incidence of adverse events.…”

mentioning

confidence: 99%

Pediatric Procedural Sedation with Ketamine: Time to Discharge after Intramuscular versus Intravenous Administration

Ramaswamy

Babl

Deasy

et al. 2009

Academic Emergency Medicine

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Objectives: Ketamine is an attractive agent for pediatric procedural sedation. There are limited data on time to discharge comparing intramuscular (IM) vs. intravenous (IV) ketamine. The authors set out to determine whether IM or IV ketamine leads to quicker discharge from the emergency department (ED) and how side effect profiles compare.Methods: All patients who had received ketamine IM or IV at a tertiary children's hospital ED during the 3-year study period (2004)(2005)(2006)(2007) were identified. Prospective sedation registry data, retrospective medical records, and administrative data were reviewed for drug dosages, use of additional agents, time of drug administration to discharge, total ED time (triage to discharge), and adverse events. A subgroup analysis for patients requiring five or fewer sutures (short suture group) was performed.Results: A total of 229 patients were enrolled (60% male) with median age of 2.8 years (IQR = 1.8-4.3 years) and median weight of 15.7 kg (range = 8.7-74 kg). Ketamine was most frequently employed for laceration repair (80%) and foreign body removal (9%). Overall, 48% received ketamine IM and 52% received it IV. In the short-suture subgroup, 52% received ketamine IM, while 48% received it IV. Multivariate linear regression analysis determined time from drug administration to patient discharge as 21 minutes shorter for IV compared with IM administration, adjusted for age and number of additional doses (R 2 = )0.35; 95% CI = )0.5 to )0.19; p < 0.001). Total time in the ED (triage to discharge) comparing IV versus IM administration, adjusting for age and gender and number of additional doses, was not significantly different (p = 0.16). In the short-suture subgroup, time to discharge from administration was also shorter in the IV ketamine group (R 2 = )0.454; 95%CI = )0.66 to )0.25; p < 0.001) but similar for total time in ED (p = 0.16). Overall, adverse events occurred in 35% (95% CI = 27% to 45%) of the IM group and 20% (95% CI = 13% to 28%) of the IV group (p = 0.01). Only one patient required brief bag-mask ventilation. Conclusions:In this institution, time from drug injection to discharge was shorter in the IV compared to IM ketamine group, both overall and for the short-suture group. However, time from triage to discharge was similar.

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“…Similar rates have been demonstrated by other groups. [8] In our series no ketamine related complications were recorded, however we do acknowledge the relatively smaller study population.…”

Section: Discussionmentioning

confidence: 99%

General Anesthesia In A Patient With Complete Atrioventricular Block For Permanent Pacemaker Implantation Without A Temporary Pacing

2003

IJA

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The purpose of this study was to evaluate the early outcome following the manipulation of distal radius and ulna fractures under ketamine sedation in paediatric patients.Patients presenting with fractures of the distal radius and ulna and manipulated in the Emergency department (ED) were identified from the ED databases and retrospectively reviewed. 40 children were identified. No patient had neurovascular (NV) symptoms prior to manipulation under anaesthetic (MUA). No patients required admission for complications related to ketamine sedation following MUA. Fracture angulation improved significantly. 4 patients required admission for repeat MUA +/-K-wire stabilisation/open reduction internal fixation (ORIF) due to failure of reduction. There were no neurological/vascular complications on discharge. All patients had made excellent functional recovery on discharge. Manipulation of paediatric forearm fractures under ketamine is safe. Excellent radiological and clinical results were noted for the majority of patients. Most requiring further operative intervention were all completely displaced on radiographs in two orthogonal views. We therefore highlight a fracture pattern that is not suitable for MUA in the absence of portable x-ray.

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The Lancaster experience of 2.0 to 2.5 mg/kg intramuscular ketamine for paediatric sedation: 501 cases and analysis

Cited by 75 publications

References 30 publications

Predictors of emesis in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

Predictors of emesis in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

Pediatric Procedural Sedation with Ketamine: Time to Discharge after Intramuscular versus Intravenous Administration

General Anesthesia In A Patient With Complete Atrioventricular Block For Permanent Pacemaker Implantation Without A Temporary Pacing

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