Ketamine sedation for children in the emergency department

Emerg Med (Fremantle). 2001 Mar;13(1):82-90. doi: 10.1046/j.1442-2026.2001.00184.x.

Abstract

Objective: To introduce a protocol for dissociative sedation using ketamine for children requiring painful procedures within the emergency department.

Method: A medical literature search was performed along with a review of existing ketamine-use protocols in emergency departments from Australia and the United States. Our hospital anaesthetic department and our emergency department nursing staff were closely involved in protocol design. A series of nursing education sessions were held prior to the drug being used within the emergency department. Twenty-eight children aged 1.5-12 years were administered ketamine sedation prior to undergoing a painful procedure. Ketamine was administered either i.m. (dose 3-4 mg/kg) or i.v. (dose 1.00-2.75 mg/kg) depending on physician preference. Midazolam (dose 0.02 mg/kg) and atropine (dose 0.02 mg/kg) were given as adjuncts in the majority of cases.

Results: Onset of sedation was rapid (range 1-7 min) for both routes and provided excellent procedural conditions. Discharge time averaged 103 min (range 67-180 min) from time of drug administration. Side-effects included vomiting, rash, diplopia, salivation and one case of a distressing emergence reaction. On telephone follow up 1-3 days after the sedation, no delayed adverse events were reported.

Conclusion: Ketamine is a safe and effective sedative agent for use in children requiring immobilization to enable performance of a painful procedure. It is important to involve both anaesthetic staff and emergency department nursing staff in sedation protocol development to ensure a smooth introduction. We present a protocol for ketamine use in children undergoing painful procedures within the emergency department.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adjuvants, Anesthesia / therapeutic use
  • Anesthetics, Dissociative / administration & dosage
  • Anesthetics, Dissociative / adverse effects
  • Anesthetics, Dissociative / therapeutic use*
  • Atropine / therapeutic use
  • Child
  • Child, Preschool
  • Clinical Protocols*
  • Emergency Treatment
  • Humans
  • Infant
  • Ketamine / administration & dosage
  • Ketamine / adverse effects
  • Ketamine / therapeutic use*
  • Midazolam / therapeutic use
  • Nursing Staff, Hospital / education
  • Pilot Projects
  • Safety Management / organization & administration*
  • Victoria
  • Wounds and Injuries / surgery

Substances

  • Adjuvants, Anesthesia
  • Anesthetics, Dissociative
  • Ketamine
  • Atropine
  • Midazolam