TY - JOUR
T1 - Optimal dosing of intravenous ketamine for procedural sedation in children in the ED—a randomized controlled trial
AU - Kannikeswaran, Nirupama
AU - Lieh-Lai, Mary
AU - Malian, Monica
AU - Wang, Bo
AU - Farooqi, Ahmad
AU - Roback, Mark G.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Objective The objective of the study is to compare need for redosing, sedation efficacy, duration, and adverse events between 3 commonly administered doses of parenteral ketamine in the emergency department (ED). Methods We conducted a prospective, double-blind, randomized controlled trial on a convenience sample of children 3 to 18 years who received intravenous ketamine for procedural sedation. Children from each age group (3-6, 7-12, and 13-18 years) were assigned in equal numbers to 3 dosing groups (1, 1.5, and 2 mg/kg) using random permuted blocks. The primary outcome measure was need for ketamine redosing to ensure adequate sedation. Secondary outcome measures were sedation efficacy, sedation duration, and sedation-related adverse events. Results A total of 171 children were enrolled of whom 125 (1 mg/kg, 50; 1.5 mg/kg, 35; 2 mg/kg, 40) received the randomized dose and were analyzed. The need for ketamine redosing was higher in the 1 mg/kg group (8/50; 16.0% vs 1/35; 2.9% vs 2/40; 5.0%). There was no significant difference in the median Ramsay sedation scores (5.5 [interquartile range {IQR}, 4-6] vs 6 [IQR, 4-6] vs 6 [IQR, 5-6]), FACES-R score (0 [IQR, 0-4] vs 0 [IQR, 0-0] vs 0 [IQR, 0-0]), sedation duration in minutes (23 [IQR, 19-38] vs 24.5 [IQR, 17.5-34.5] vs 23 [IQR, 19-29]), and adverse events (10.0% vs 14.3% vs 10.0%) between the 3 dosing groups. Physician satisfaction was lower in the 1 mg/kg group (79.6% vs 94.1% vs 97.3%). Conclusions Adequate sedation was achieved with all 3 doses of ketamine. Higher doses did not increase the risk of adverse events or prolong sedation. Ketamine administered at 1.5 or 2.0 mg/kg intravenous required less redosing and resulted in greater physician satisfaction.
AB - Objective The objective of the study is to compare need for redosing, sedation efficacy, duration, and adverse events between 3 commonly administered doses of parenteral ketamine in the emergency department (ED). Methods We conducted a prospective, double-blind, randomized controlled trial on a convenience sample of children 3 to 18 years who received intravenous ketamine for procedural sedation. Children from each age group (3-6, 7-12, and 13-18 years) were assigned in equal numbers to 3 dosing groups (1, 1.5, and 2 mg/kg) using random permuted blocks. The primary outcome measure was need for ketamine redosing to ensure adequate sedation. Secondary outcome measures were sedation efficacy, sedation duration, and sedation-related adverse events. Results A total of 171 children were enrolled of whom 125 (1 mg/kg, 50; 1.5 mg/kg, 35; 2 mg/kg, 40) received the randomized dose and were analyzed. The need for ketamine redosing was higher in the 1 mg/kg group (8/50; 16.0% vs 1/35; 2.9% vs 2/40; 5.0%). There was no significant difference in the median Ramsay sedation scores (5.5 [interquartile range {IQR}, 4-6] vs 6 [IQR, 4-6] vs 6 [IQR, 5-6]), FACES-R score (0 [IQR, 0-4] vs 0 [IQR, 0-0] vs 0 [IQR, 0-0]), sedation duration in minutes (23 [IQR, 19-38] vs 24.5 [IQR, 17.5-34.5] vs 23 [IQR, 19-29]), and adverse events (10.0% vs 14.3% vs 10.0%) between the 3 dosing groups. Physician satisfaction was lower in the 1 mg/kg group (79.6% vs 94.1% vs 97.3%). Conclusions Adequate sedation was achieved with all 3 doses of ketamine. Higher doses did not increase the risk of adverse events or prolong sedation. Ketamine administered at 1.5 or 2.0 mg/kg intravenous required less redosing and resulted in greater physician satisfaction.
UR - http://www.scopus.com/inward/record.url?scp=84969509050&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84969509050&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2016.03.064
DO - 10.1016/j.ajem.2016.03.064
M3 - Article
C2 - 27216835
AN - SCOPUS:84969509050
VL - 34
SP - 1347
EP - 1353
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
IS - 8
ER -