Ketamine Use in Children

methyl_ethyl · Riedel De Haen

This thread will discuss the clinical usage of ketamine in children, and also cover topics such as why the clinical use of ketamine is often not often utilized in adults.

Rhodium posted excellent discourse as to why adults do not tolerate ketamine induced anaesthesia / analgesia without the administration of amnesia inducing benzodiaziapines. His thoughts mirrored my thoughts verbatim. I may have been part of the discussion but do not remember. It would be grateful if someone could dig up postings from the hive concerning ketamine, children, emergency medicine, and the like, I am sure Rhodi's post and perhaps literature posted by myself would be found there.

"Emergence Syndromes" would not be a problem if adults were able to open their minds to "altered states". From my perspective this is the only reason why adult ketamine administration is not widely utilized in anaesthesia in most civilized communities. Children tolerate the dissociative state quite well, most adults seem to loose this tolerance of dissociation at some point in their lives, those of us that age and still are able to manipulate reality would fair quite well under ketamine, without the need for amnesia inducing drugs IMO. The positve effects of ketamine far outweigh the mal at least in my opinion, regarding anaesthesia, and the like.

Oh well,

The Lancaster experience of 2.0 to 2.5 mg/kg intramuscular ketamine for paediatric sedation: 501 cases and analysis
R G McGlone, M C Howes and M Joshi
Emerg Med J 2004; 21:290-295

Full Text

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.

Keywords: ketamine; paediatric; sedation

methyl_ethyl · Riedel De Haen

Procedural sedation in paediatric minor procedures: a prospective audit on ketamine use in the emergency department
D Y Ellis, H M Husain, J P Saetta, and T Walker
Emerg Med J 2004; 21:286-289
full text

Objectives: To further evaluate the safety profile and efficacy of intramuscular ketamine for procedural sedation during paediatric minor procedures in the emergency department and to ascertain parental satisfaction with the treatment of their children.

Methods: A prospective audit of ketamine use in a UK district general hospital involving 89 children requiring minor procedures. Children received topical anaesthesia followed by an intramuscular injection of ketamine 4 mg/kg and intramuscular atropine 0.02 mg/kg. The procedure was assessed by way of a physician completed form and by evaluation of questionnaires given to parents to gauge levels of satisfaction.

Results: No child required admission to hospital and there were no serious complications. A high level of satisfaction was expressed by all the parents/guardians of the children treated.

Conclusions: High levels of satisfaction among parents and staff together with the avoidance of hospital admission and improved resource management should be a sufficient incentive for hospital trusts to consider the establishment of this type of service.

regards,

methyl_ethyl

methyl_ethyl · Riedel De Haen

Ketamine for paediatric sedation/analgesia in the emergency department
M.C. Howes
Emerg Med J 2004;21:275–280.
full text

This review investigates the use of ketamine for paediatric
sedation and analgesia in the emergency department

wow what an abstract!

or not, good article however....

regards,

methyl_ethyl