Study objective: To determine efficacy, safety, recovery times, and parental satisfaction with i.v. ketamine sedation in pediatric patients requiring brief, painful procedures in the emergency department.
Methods: Pediatric ED patients whom we found to require brief (< 10 minutes), painful procedures were considered candidates for ketamine sedation. Each subject received 1.0 to 2.0 mg/kg i.v. ketamine, after which the necessary procedure was performed.
Result: Thirty patients, ranging in age from 18 months to 8 years, were enrolled in the study. With the exception of one patients in whom ketamine was inadvertently given subcutaneously, all subjects given i.v. ketamine exhibited sedation adequate for the planned painful procedure within 2 minutes of ketamine administration. An initial bolus of 1.0 mg/kg required supplemental administration of ketamine in 50% of the patients (6 of 12), whereas an initial bolus of 1.5 mg/kg reliably produced adequate sedation in 94% (17 of 18). The median time elapsed before the criteria for discharge after injection were fulfilled was 25 minutes. No deleterious cardiopulmonary effects were noted. Vomiting and mild agitation after the procedure were observed in two and four cases, respectively. At follow-up all parents reported satisfaction with ketamine sedation.
Conclusion: I.v. ketamine is a consistently effective method of producing a rapid, brief period of profound sedation and analgesia in children in the ED. Although no serious complications were noted in our series, larger studies are needed to establish this drug's safety profile in the ED. Vomiting, ataxia, and agitation were noted in a few cases.