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. 2004 May;21(3):275–280. doi: 10.1136/emj.2003.005769

Ketamine for paediatric sedation/analgesia in the emergency department

M Howes 1
PMCID: PMC1726352  PMID: 15107362

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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. Blackburn P., Vissers R. Pharmacology of emergency department pain management and conscious sedation. Emerg Med Clin North Am. 2000 Nov;18(4):803–827. doi: 10.1016/s0733-8627(05)70160-7. [DOI] [PubMed] [Google Scholar]
  3. Carley S., Martin B. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Midazolam and emergence phenomena in children undergoing ketamine sedation. Emerg Med J. 2001 Jul;18(4):273–274. doi: 10.1136/emj.18.4.273-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cottingham R., Thomson K. Use of ketamine in prolonged entrapment. J Accid Emerg Med. 1994 Sep;11(3):189–191. doi: 10.1136/emj.11.3.189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. 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]
  6. Doyle E. Emergency analgesia in the paediatric population. Part IV Paediatric sedation in the accident and emergency department: pros and cons. Emerg Med J. 2002 Jul;19(4):284–287. doi: 10.1136/emj.19.4.284. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. 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]
  8. 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]
  9. Everitt Ian, Younge Paul, Barnett Peter. Paediatric sedation in emergency department: what is our practice? Emerg Med (Fremantle) 2002 Mar;14(1):62–66. doi: 10.1046/j.1442-2026.2002.00285.x. [DOI] [PubMed] [Google Scholar]
  10. Glickman A. Ketamine: the dissociative anesthetic and the development of a policy for its safe administration in the pediatric emergency department. J Emerg Nurs. 1995 Apr;21(2):116–124. doi: 10.1016/s0099-1767(05)80010-8. [DOI] [PubMed] [Google Scholar]
  11. Gofrit O. N., Leibovici D., Shemer J., Henig A., Shapira S. C. Ketamine in the field: the use of ketamine for induction of anaesthesia before intubation in injured patients in the field. Injury. 1997 Jan;28(1):41–43. doi: 10.1016/S0020-1383(96)00140-4. [DOI] [PubMed] [Google Scholar]
  12. Green S. M., Clark R., Hostetler M. A., Cohen M., Carlson D., Rothrock S. G. Inadvertent ketamine overdose in children: clinical manifestations and outcome. Ann Emerg Med. 1999 Oct;34(4 Pt 1):492–497. doi: 10.1016/s0196-0644(99)80051-1. [DOI] [PubMed] [Google Scholar]
  13. 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]
  14. 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]
  15. 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]
  16. Green S. M., Klooster M., Harris T., Lynch E. L., Rothrock S. G. Ketamine sedation for pediatric gastroenterology procedures. J Pediatr Gastroenterol Nutr. 2001 Jan;32(1):26–33. doi: 10.1097/00005176-200101000-00010. [DOI] [PubMed] [Google Scholar]
  17. 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]
  18. 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]
  19. Green S. M., Li J. Ketamine in adults: what emergency physicians need to know about patient selection and emergence reactions. Acad Emerg Med. 2000 Mar;7(3):278–281. doi: 10.1111/j.1553-2712.2000.tb01076.x. [DOI] [PubMed] [Google Scholar]
  20. Green S. M. Modern anesthesiologists receive limited training with ketamine--implications for emergency medicine. Acad Emerg Med. 2000 Jul;7(7):839–841. doi: 10.1111/j.1553-2712.2000.tb02284.x. [DOI] [PubMed] [Google Scholar]
  21. 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]
  22. 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]
  23. 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]
  24. Green Steven M., Krauss Baruch. Pulmonary aspiration risk during emergency department procedural sedation--an examination of the role of fasting and sedation depth. Acad Emerg Med. 2002 Jan;9(1):35–42. doi: 10.1197/aemj.9.1.35. [DOI] [PubMed] [Google Scholar]
  25. Greenhalgh T. How to read a paper. The Medline database. BMJ. 1997 Jul 19;315(7101):180–183. doi: 10.1136/bmj.315.7101.180. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Heckman J. D. The use of ketamine sedation. J Bone Joint Surg Am. 2000 Jul;82-A(7):911–911. doi: 10.2106/00004623-200007000-00001. [DOI] [PubMed] [Google Scholar]
  27. 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]
  28. Hostetler Mark A., Auinger Peggy, Szilagyi Peter G. Parenteral analgesic and sedative use among ED patients in the United States: combined results from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 1992-1997. Am J Emerg Med. 2002 Mar;20(2):83–87. doi: 10.1053/ajem.2002.31578. [DOI] [PubMed] [Google Scholar]
  29. Ilkhanipour K., Juels C. R., Langdorf M. I. Pediatric pain control and conscious sedation: a survey of emergency medicine residencies. Acad Emerg Med. 1994 Jul-Aug;1(4):368–372. doi: 10.1111/j.1553-2712.1994.tb02647.x. [DOI] [PubMed] [Google Scholar]
  30. Kapklein Matthew J., Slonim Anthony D. Ketamine vs. propofol: how safe is safe enough? Crit Care Med. 2002 Jun;30(6):1384–1386. doi: 10.1097/00003246-200206000-00045. [DOI] [PubMed] [Google Scholar]
  31. Kennedy R. M., Luhmann J. D. The "ouchless emergency department". Getting closer: advances in decreasing distress during painful procedures in the emergency department. Pediatr Clin North Am. 1999 Dec;46(6):1215-47, vii-viii. doi: 10.1016/s0031-3955(05)70184-x. [DOI] [PubMed] [Google Scholar]
  32. Kennedy R. M., Porter F. L., Miller J. P., Jaffe D. M. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics. 1998 Oct;102(4 Pt 1):956–963. doi: 10.1542/peds.102.4.956. [DOI] [PubMed] [Google Scholar]
  33. 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]
  34. Kleinknecht R. A. Acquisition of blood, injury, and needle fears and phobias. Behav Res Ther. 1994 Nov;32(8):817–823. doi: 10.1016/0005-7967(94)90161-9. [DOI] [PubMed] [Google Scholar]
  35. Komatsu T., Singh P. K., Kimura T., Nishiwaki K., Bando K., Shimada Y. Differential effects of ketamine and midazolam on heart rate variability. Can J Anaesth. 1995 Nov;42(11):1003–1009. doi: 10.1007/BF03011073. [DOI] [PubMed] [Google Scholar]
  36. L'Hommedieu C. S., Arens J. J. The use of ketamine for the emergency intubation of patients with status asthmaticus. Ann Emerg Med. 1987 May;16(5):568–571. doi: 10.1016/s0196-0644(87)80688-1. [DOI] [PubMed] [Google Scholar]
  37. Maurice S. C., O'Donnell J. J., Beattie T. F. Emergency analgesia in the paediatric population. Part II Pharmacological methods of pain relief. Emerg Med J. 2002 Mar;19(2):101–105. doi: 10.1136/emj.19.2.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. 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]
  39. McGlone R. G., Howes M. C., Joshi M. The Lancaster experience of 2.0 to 2.5 mg/kg intramuscular ketamine for paediatric sedation: 501 cases and analysis. Emerg Med J. 2004 May;21(3):290–295. doi: 10.1136/emj.2002.003772. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. 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]
  41. 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]
  42. 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]
  43. Ng K. C., Ang S. Y. Sedation with ketamine for paediatric procedures in the emergency department--a review of 500 cases. Singapore Med J. 2002 Jun;43(6):300–304. [PubMed] [Google Scholar]
  44. O'Donnell J. J., Maurice S. C., Beattie T. F. Emergency analgesia in the paediatric population. Part III non-pharmacological measures of pain relief and anxiolysis. Emerg Med J. 2002 May;19(3):195–197. doi: 10.1136/emj.19.3.195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Park G. R., Manara A. R., Mendel L., Bateman P. E. Ketamine infusion. Its use as a sedative, inotrope and bronchodilator in a critically ill patient. Anaesthesia. 1987 Sep;42(9):980–983. doi: 10.1111/j.1365-2044.1987.tb05370.x. [DOI] [PubMed] [Google Scholar]
  46. Pederson L., Benumof J. Incidence and magnitude of hypoxaemia with ketamine in a rural African hospital. Anaesthesia. 1993 Jan;48(1):67–69. doi: 10.1111/j.1365-2044.1993.tb06798.x. [DOI] [PubMed] [Google Scholar]
  47. Peña B. M., Krauss B. Adverse events of procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med. 1999 Oct;34(4 Pt 1):483–491. doi: 10.1016/s0196-0644(99)80050-x. [DOI] [PubMed] [Google Scholar]
  48. 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]
  49. 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]
  50. Sadove M. S., Shulman M., Hatano S., Fevold N. Analgesic effects of ketamine administered in subdissociative doses. Anesth Analg. 1971 May-Jun;50(3):452–457. [PubMed] [Google Scholar]
  51. Sherwin T. S., Green S. M., Khan A., Chapman D. S., Dannenberg B. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2000 Mar;35(3):229–238. doi: 10.1016/s0196-0644(00)70073-4. [DOI] [PubMed] [Google Scholar]
  52. Smith J. A., Santer L. J. Respiratory arrest following intramuscular ketamine injection in a 4-year-old child. Ann Emerg Med. 1993 Mar;22(3):613–615. doi: 10.1016/s0196-0644(05)81956-0. [DOI] [PubMed] [Google Scholar]
  53. 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]
  54. Strube P. J., Hallam P. L. Ketamine by continuous infusion in status asthmaticus. Anaesthesia. 1986 Oct;41(10):1017–1019. doi: 10.1111/j.1365-2044.1986.tb12744.x. [DOI] [PubMed] [Google Scholar]
  55. Sussman D. R. A comparative evaluation of ketamine anesthesia in children and adults. Anesthesiology. 1974 May;40(5):459–464. doi: 10.1097/00000542-197405000-00012. [DOI] [PubMed] [Google Scholar]
  56. 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]
  57. Trigwell P. J. Iatrogenic needle phobia. Br Dent J. 1993 Mar 6;174(5):158–158. doi: 10.1038/sj.bdj.4808104. [DOI] [PubMed] [Google Scholar]
  58. Wathen J. E., Roback M. G., Mackenzie T., Bothner J. P. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, emergency department trial. Ann Emerg Med. 2000 Dec;36(6):579–588. doi: 10.1067/mem.2000.111131. [DOI] [PubMed] [Google Scholar]
  59. 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]
  60. 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]
  61. Youssef-Ahmed M. Z., Silver P., Nimkoff L., Sagy M. Continuous infusion of ketamine in mechanically ventilated children with refractory bronchospasm. Intensive Care Med. 1996 Sep;22(9):972–976. doi: 10.1007/BF02044126. [DOI] [PubMed] [Google Scholar]

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