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. 2004 May;21(3):290–295. doi: 10.1136/emj.2002.003772

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

R McGlone 1, M Howes 1, M Joshi 1
PMCID: PMC1726347  PMID: 15107365

Abstract

Objectives: To report the experience of using intramuscular ketamine 2.0 or 2.5 mg/kg for minor painful procedures in children in a medium sized district general hospital accident and emergency department. To demonstrate the safety and acceptability of ketamine and determine if the incidence of adverse effects is related to dose or other variables.

Methods: Prospective data collection and analysis using Statsdirect and SPSS software.

Results: 501 consecutive cases were collected from August 1996 to April 2002. A total of 310 children received 2.0 mg/kg and 191 received 2.5 mg/kg. Twenty six received a second dose. In seven cases oxygen saturation fell below 93%, three of these fell below 90%. There was one case of laryngospasm. Eight cases received airway suctioning, five of these were mouth or lip wounds. Seventeen per cent vomited in recovery or at home for which one child required admission. Muscle hypertonicity was observed in 6.8%, disturbed sleep or nightmares in 2%. The median time to discharge was 85 minutes. Ninety seven per cent of parents' experiences were "the same as" or "better than" expected. No children suffered any lasting or troublesome complications.

Conclusions: 2.0 – 2.5 mg/kg intramuscular ketamine sedation is a safe and acceptable technique when used within a defined protocol. Lower dose ketamine (2 mg/kg) warrants further study in view of potentially less airway complications and quicker discharge times than previously reported.

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Selected References

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  1. Acworth J. P., Purdie D., Clark R. C. Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation. Emerg Med J. 2001 Jan;18(1):39–45. doi: 10.1136/emj.18.1.39. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Chudnofsky C. R., Weber J. E., Stoyanoff P. J., Colone P. D., Wilkerson M. D., Hallinen D. L., Jaggi F. M., Boczar M. E., Perry M. A. A combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department patients. Acad Emerg Med. 2000 Mar;7(3):228–235. doi: 10.1111/j.1553-2712.2000.tb01064.x. [DOI] [PubMed] [Google Scholar]
  3. Dachs R. J., Innes G. M. Intravenous ketamine sedation of pediatric patients in the emergency department. Ann Emerg Med. 1997 Jan;29(1):146–150. doi: 10.1016/s0196-0644(97)70321-4. [DOI] [PubMed] [Google Scholar]
  4. Ducharme J. Ketamine: do what is right for the patient. Emerg Med (Fremantle) 2001 Mar;13(1):7–8. doi: 10.1046/j.1442-2026.2001.00171.x. [DOI] [PubMed] [Google Scholar]
  5. Epstein F. B. Ketamine dissociative sedation in pediatric emergency medical practice. Am J Emerg Med. 1993 Mar;11(2):180–182. doi: 10.1016/0735-6757(93)90115-r. [DOI] [PubMed] [Google Scholar]
  6. Friedberg B. L. Propofol-ketamine technique: dissociative anesthesia for office surgery (a 5-year review of 1264 cases). Aesthetic Plast Surg. 1999 Jan-Feb;23(1):70–75. doi: 10.1007/s002669900245. [DOI] [PubMed] [Google Scholar]
  7. Green S. M., Clem K. J., Rothrock S. G. Ketamine safety profile in the developing world: survey of practitioners. Acad Emerg Med. 1996 Jun;3(6):598–604. [PubMed] [Google Scholar]
  8. Green S. M., Hummel C. B., Wittlake W. A., Rothrock S. G., Hopkins G. A., Garrett W. What is the optimal dose of intramuscular ketamine for pediatric sedation? Acad Emerg Med. 1999 Jan;6(1):21–26. doi: 10.1111/j.1553-2712.1999.tb00089.x. [DOI] [PubMed] [Google Scholar]
  9. Green S. M., Johnson N. E. Ketamine sedation for pediatric procedures: Part 2, Review and implications. Ann Emerg Med. 1990 Sep;19(9):1033–1046. doi: 10.1016/s0196-0644(05)82569-7. [DOI] [PubMed] [Google Scholar]
  10. Green S. M., Krauss B. The semantics of ketamine. Ann Emerg Med. 2000 Nov;36(5):480–482. doi: 10.1067/mem.2000.109510. [DOI] [PubMed] [Google Scholar]
  11. Green S. M., Kuppermann N., Rothrock S. G., Hummel C. B., Ho M. Predictors of adverse events with intramuscular ketamine sedation in children. Ann Emerg Med. 2000 Jan;35(1):35–42. doi: 10.1016/s0196-0644(00)70102-8. [DOI] [PubMed] [Google Scholar]
  12. Green S. M., Nakamura R., Johnson N. E. Ketamine sedation for pediatric procedures: Part 1, A prospective series. Ann Emerg Med. 1990 Sep;19(9):1024–1032. doi: 10.1016/s0196-0644(05)82568-5. [DOI] [PubMed] [Google Scholar]
  13. Green S. M., Rothrock S. G., Harris T., Hopkins G. A., Garrett W., Sherwin T. Intravenous ketamine for pediatric sedation in the emergency department: safety profile with 156 cases. Acad Emerg Med. 1998 Oct;5(10):971–976. doi: 10.1111/j.1553-2712.1998.tb02773.x. [DOI] [PubMed] [Google Scholar]
  14. Green S. M., Rothrock S. G., Lynch E. L., Ho M., Harris T., Hestdalen R., Hopkins G. A., Garrett W., Westcott K. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med. 1998 Jun;31(6):688–697. doi: 10.1016/s0196-0644(98)70226-4. [DOI] [PubMed] [Google Scholar]
  15. Green S. M. The safety of ketamine for emergency department pediatric sedation. J Oral Maxillofac Surg. 1995 Oct;53(10):1232–1233. doi: 10.1016/0278-2391(95)90654-1. [DOI] [PubMed] [Google Scholar]
  16. Holloway V. J., Husain H. M., Saetta J. P., Gautam V. Accident and emergency department led implementation of ketamine sedation in paediatric practice and parental response. J Accid Emerg Med. 2000 Jan;17(1):25–28. doi: 10.1136/emj.17.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ketcham D. W. Where there is no anaesthesiologist: the many uses of ketamine. Trop Doct. 1990 Oct;20(4):163–166. doi: 10.1177/004947559002000407. [DOI] [PubMed] [Google Scholar]
  18. Kryshtalskyj B., Direnfeld V. N., Johnson T. W. Use of low-dose ketamine hydrochloride in outpatient oral surgery. Oral Surg Oral Med Oral Pathol. 1990 Apr;69(4):413–419. doi: 10.1016/0030-4220(90)90371-x. [DOI] [PubMed] [Google Scholar]
  19. Lu D. P., Lu G. P., Reed J. F., 3rd Safety, efficacy, and acceptance of intramuscular sedation: assessment of 900 dental cases. Compendium. 1994 Nov;15(11):1348–1362. [PubMed] [Google Scholar]
  20. Mason Keira P., Michna Edward, DiNardo James A., Zurakowski David, Karian Victoria E., Connor Linda, Burrows Patricia E. Evolution of a protocol for ketamine-induced sedation as an alternative to general anesthesia for interventional radiologic procedures in pediatric patients. Radiology. 2002 Nov;225(2):457–465. doi: 10.1148/radiol.2252011786. [DOI] [PubMed] [Google Scholar]
  21. McCarty E. C., Mencio G. A., Walker L. A., Green N. E. Ketamine sedation for the reduction of children's fractures in the emergency department. J Bone Joint Surg Am. 2000 Jul;82-A(7):912–918. doi: 10.2106/00004623-200007000-00002. [DOI] [PubMed] [Google Scholar]
  22. McGlone R. G., Ranasinghe S., Durham S. An alternative to "brutacaine": a comparison of low dose intramuscular ketamine with intranasal midazolam in children before suturing. J Accid Emerg Med. 1998 Jul;15(4):231–236. doi: 10.1136/emj.15.4.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. McGlone R., Fleet T., Durham S., Hollis S. A comparison of intramuscular ketamine with high dose intramuscular midazolam with and without intranasal flumazenil in children before suturing. Emerg Med J. 2001 Jan;18(1):34–38. doi: 10.1136/emj.18.1.34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Moscona R. A., Ramon I., Ben-David B., Isserles S. A comparison of sedation techniques for outpatient rhinoplasty: midazolam versus midazolam plus ketamine. Plast Reconstr Surg. 1995 Oct;96(5):1066–1074. doi: 10.1097/00006534-199510000-00009. [DOI] [PubMed] [Google Scholar]
  25. Murphy M. F. Sedation. Ann Emerg Med. 1996 Apr;27(4):461–463. doi: 10.1016/s0196-0644(96)70232-9. [DOI] [PubMed] [Google Scholar]
  26. Priestley S. J., Taylor J., McAdam C. M., Francis P. 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. [DOI] [PubMed] [Google Scholar]
  27. Reich D. L., Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth. 1989 Mar;36(2):186–197. doi: 10.1007/BF03011442. [DOI] [PubMed] [Google Scholar]
  28. Sobel R. M., Morgan B. W., Murphy M. Ketamine in the ED: medical politics versus patient care. Am J Emerg Med. 1999 Nov;17(7):722–725. doi: 10.1016/s0735-6757(99)90169-9. [DOI] [PubMed] [Google Scholar]
  29. Tighe S. Q., Rudland S. V. Anesthesia in northern Iraq: an audit from a field hospital. Mil Med. 1994 Feb;159(2):86–90. [PubMed] [Google Scholar]
  30. Tucker M. R., Hann J. R., Phillips C. L. Subanesthetic doses of ketamine, diazepam, and nitrous oxide for adult outpatient sedation. J Oral Maxillofac Surg. 1984 Oct;42(10):668–672. doi: 10.1016/0278-2391(84)90210-6. [DOI] [PubMed] [Google Scholar]
  31. White P. F., Way W. L., Trevor A. J. Ketamine--its pharmacology and therapeutic uses. Anesthesiology. 1982 Feb;56(2):119–136. doi: 10.1097/00000542-198202000-00007. [DOI] [PubMed] [Google Scholar]
  32. Younge P. A., Kendall J. M. Sedation for children requiring wound repair: a randomised controlled double blind comparison of oral midazolam and oral ketamine. Emerg Med J. 2001 Jan;18(1):30–33. doi: 10.1136/emj.18.1.30. [DOI] [PMC free article] [PubMed] [Google Scholar]

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