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.
For procedural sedation in children >3 months without: raised intracranial or intraocular pressure; or history of psychosis.
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.
0.5 mg/kg IV; or 2-4 mg/kg IM after 10-15 mins.
Dissociative (trance-like) state; no respiratory depression; bronchodilation; excessive salivation; eyes can be open and with nystagmus.
Some give 0.02 mcg/kg atropine, but this is not proven to reduce laryngospasm (although can be useful for dental/oral procedures).
80 mins IV; 120 mins IM
- 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)