Intravenous Ketamine Sedation of Pediatric Patients in the Emergency Department☆,☆☆,★
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INTRODUCTION
The appropriate relief of pain and anxiety is essential in the management of pediatric patients undergoing painful procedures in the emergency department. To accomplish this goal, a pharmacologic agent or combination of agents should provide ease of administration, rapid onset, effective and predictable analgesia; avoid airway and cardiopulmonary compromise; and result in rapid and smooth recovery.1, 2
Ketamine hydrochloride is a unique pharmacologic agent that produces a trancelike catatonic
MATERIALS AND METHODS
This study was approved by the Institutional Review Board of Albany Memorial Hospital. Patients aged 3 months through 8 years whom we deemed to require immobilization for painful or emotionally disturbing procedures that were expected to be completed in 10 minutes or less were considered candidates for ketamine sedation. We excluded patients with acute or chronic pulmonary infection or cardiovascular disease, including hypertension; head injury associated with loss of consciousness, altered
RESULTS
Thirty children were enrolled in the study (age range, 18 months to 8 years; median, 38 months). Twenty-one were boys. Laceration repair was the most common procedure (27 of 30 [90%]). The remaining cases included removal of foreign bodies from feet and ears and lumbar puncture.
Veins in the hands and antecubital regions were most often used for IV access (17 and 13 cases, respectively). In one case, IV access was believed to be present when the characteristic “flash” of blood appeared in the
DISCUSSION
IV ketamine administration has many attractive pharmacokinetic properties that recommend it for sedation of children in the ED. A dose of 1 mg/kg has been reported to have resulted in a peak concentration and clinical effects within 1 minute.6 In our study, a dose of 1.5 mg/kg reliably produced dissociative sedation within 2 minutes.
After IV administration, ketamine is rapidly distributed into peripheral tissues, resulting in return of coherence within 15 minutes.7 We found that this property
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Cited by (0)
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From the Department of Emergency Medicine, Albany Memorial Hospital, Albany, New York.
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Address for reprints: Robert J Dachs, MD, Department of Emergency Medicine, Albany Memorial Hospital, 600 Northern Boulevard, Albany, New York 12204
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Reprint no. 47/1/78154