Stephen J Priestley, FACEM, Director of Emergency Medicine; James Taylor, DA(UK), FACEM, Staff Specialist in Emergency Medicine; Catherine M McAdam, FRACP, Consultant Paediatrician; Peter Francis, FRACP, Consultant Paediatrician.
Ketamine sedation for children in the emergency department
Article first published online: 7 JUL 2008
Volume 13, Issue 1, pages 82–90, March 2001
How to Cite
Priestley, S. J., Taylor, J., McAdam, C. M. and Francis, P. (2001), Ketamine sedation for children in the emergency department. Emergency Medicine, 13: 82–90. doi: 10.1046/j.1442-2026.2001.00184.x
- Issue published online: 7 JUL 2008
- Article first published online: 7 JUL 2008
To introduce a protocol for dissociative sedation using ketamine for children requiring painful procedures within the emergency department.
A medical literature search was performed along with a review of existing ketamine-use protocols in emergency departments from Australia and the United States. Our hospital anaesthetic department and our emergency department nursing staff were closely involved in protocol design. A series of nursing education sessions were held prior to the drug being used within the emergency department. Twenty-eight children aged 1.5–12 years were administered ketamine sedation prior to undergoing a painful procedure. Ketamine was administered either i.m. (dose 3–4 mg/kg) or i.v. (dose 1.00–2.75 mg/kg) depending on physician preference. Midazolam (dose 0.02 mg/kg) and atropine (dose 0.02 mg/kg) were given as adjuncts in the majority of cases.
Onset of sedation was rapid (range 1–7 min) for both routes and provided excellent procedural conditions. Discharge time averaged 103 min (range 67–180 min) from time of drug administration. Side-effects included vomiting, rash, diplopia, salivation and one case of a distressing emergence reaction. On telephone follow up 1–3 days after the sedation, no delayed adverse events were reported.
Ketamine is a safe and effective sedative agent for use in children requiring immobilization to enable performance of a painful procedure. It is important to involve both anaesthetic staff and emergency department nursing staff in sedation protocol development to ensure a smooth introduction. We present a protocol for ketamine use in children undergoing painful procedures within the emergency department. See Commentary, page 7.