Procedural sedation - ketamine

Ketamine for procedural sedation

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The role of ketamine in procedural sedation has already been covered thoroughly and fabulously on FOAM.  So we are not going to replicate all that hard work here.  Instead check out the links below which cover everything you need to know; and read our very brief overview.

Paediatric Procedural Sedation by Chris Nickson, Life in the Fast Lane

Nasal Foreign Body, Ketamine and Laryngospam by Chris Nickson, Life in the Fast Lane

Ketamine by Brad Sobolewski, PEM Currents

Intranasal Ketamine, Mum ‘Nose’ Best by Natalie May, St Emlyn’s

 

When:

For procedural sedation in children >3 months without: raised intracranial or intraocular pressure; or history of psychosis.

 

Fasting time:

4 hours

 

Dose:

1-1.5 mg/kg IV (works in 1-2 mins, lasts 10-20 mins); 4-5 mg IM (works in 2-5 mins, lasts 15-30 mins); oral and IN is also an option.

 

Top-up doses:

0.5 mg/kg IV; or 2-4 mg/kg IM after 10-15 mins.

 

Effects:

Dissociative (trance-like) state; no respiratory depression; bronchodilation; excessive salivation; eyes can be open and with nystagmus.

 

Concurrent atropine?:

Some give 0.02 mcg/kg atropine, but this is not proven to reduce laryngospasm (although can be useful for dental/oral procedures).

 

Recovery time:

80 mins IV; 120 mins IM

 

Complications:

  • Laryngospams (0.4%) – minimise risk by giving ketamine over 2 minutes
  • Emergence reactions (7.6%) – minimise risk by keeping calm and happy before sedation and can give benzodiazepines
  • Vomiting – can given ondansetron prior to procedure (NNT 13)

 

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Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa's DFTB posts