S-KETAMINE SEDATION IN A TERTIARY PAEDIATRIC EMERGENCY DEPARTMENT

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Abstract

Objectives & Background

To discuss the use of S-Ketamine for minor injuries in a tertiary Paediatric Emergency Department (PED), using a literature review of the topic and retrospective review of the department's first 200 patient's experience.

Methods

A literature review of Ketamine was carried out on procedural sedation using Ketamine in children in the Emergency Department. This was combined with a retrospective audit of Alder Hey Hospital departmental practise of the first 200 patients undergoing this method of sedation. The first 200 patients were cumulatively recorded by the researchers and their case notes reviewed for indication for sedation, dose given, adjuntive medications used and adverse reactions.

Results

There is ample literature data to support the use of ketamine for procedural sedation in the paediatric emergency department. In the audit, 200 patients were adequately sedated using IV ketamine with a mean dose of 1.1 mg/kg and a median dose of 1 mg/kg. The procedures carried out included laceration repair (46%), foreign body removal (17.5%), reduction of fracture or dislocation (29%) and other procedures (7.5%). 40 (19.8%) experienced an adverse reaction, the commonest of which was vomiting (7.9%), followed by airway problems (4.9%) and confusion (2%). 8 (3%) patients required adjunctive medication (ondansetron (6); midazolam (2)).

Conclusion

S-Ketamine is safe to use in the PED for sedation for minor injuries and procedures. However, further studies are needed to determine the correct dose regimen and to determine methods of decreasing adverse events.

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