Ketamine for Conscious Sedation in Pediatric Emergency Care

Rakhee B. Mistry; Milap C. Nahata, PharmD

Disclosures

Pharmacotherapy. 2005;25(8):1104-1111. 

In This Article

Guidelines for Ketamine Use

A clinical practice guideline stated that ketamine is optimal for sedation during brief procedures that are painful or emotionally disturbing for children, such as fracture reduction and laceration repair.[35] Ketamine is not recommended as a sedative for patients undergoing computed tomography or magnetic resonance imaging, and is contraindicated for infants younger than 3 months and patients with established psychosis. The optimal ketamine dose is 1.5 mg/kg intravenously and 4-5 mg/kg intramuscularly. Both intravenous and intra-muscular routes are considered equally safe and effective in achieving sedation. Concurrent administration of an antisialagogue with ketamine is not necessary due to a lack of studies supporting associated benefits. If an antisialagogue is administered, atropine is recommended because of experience with this agent in emergency departments. Glycopyrrolate is equally acceptable.

Benzodiazepines have been coadministered with ketamine to reduce the frequency of emergence phenomena. However, two studies failed to document a trend toward any benefit from administering benzodiazepines with ketamine.[36,37] Emergence reactions have rarely been severe in children; only 1.6% of such reactions were judged more severe than mild in one study.[22] Benzodiazepines have been effective in alleviating the rare unpleasant emergence reaction and can be administered if one does occur.[11,22,27,31,35]

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