Intravenous ketamine for pediatric sedation in the Emergency Department: Safety profile with 156 cases

Objectives: To determine the safety of IV ketamine when administered by emergency physicians (EPs) for pediatric procedures, and to contrast the sedation characteristics of the IV and IM routes. Methods: The study was a retrospective consecutive case series of children aged ≤15 years given IV ketamine in the EDs of a university medical center and an affiliated county hospital over a 9-year period. A protocol for ketamine was used by treating physicians. Records were reviewed for adverse effects, indication, dosing, adjunctive drugs, inadequate sedation, and time to release. Results were contrasted with previously reported data for the IM route. Results: During the study period IV ketamine was administered 156 times, primarily for laceration repair and fracture reduction. Transient apnea and respiratory depression occurred in one patient each; both were quickly identified and were without sequelae. Laryngospasm or aspiration was not noted in any children. There were 6 children with emesis and 2 with mild agitation during recovery. The median time from initial dose to ED release was 103 minutes (25th to 75th percentiles 76 to 146 minutes). The IV and IM routes were comparable in terms of adverse effects, inadequate sedation, and time to release. Conclusion: IV ketamine can be administered safely by EPs to facilitate pediatric procedures when used in a defined protocol. The sedation characteristics of the IV and IM routes appear comparable.