Optimal dosing of intravenous ketamine for procedural sedation in children in the ED—a randomized controlled trial

Nirupama Kannikeswaran, Mary Lieh-Lai, Monica Malian, Bo Wang, Ahmad Farooqi, Mark G. Roback

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1347-1353
Number of pages7
JournalAmerican Journal of Emergency Medicine
Volume34
Issue number8
DOIs
StatePublished - Aug 1 2016

Bibliographical note

Funding Information:
Grant funding: This study was supported by the “New Investigator Grant Program,” Children's Research Foundation of Michigan as well as Children's Hospital of Michigan Foundation Grant.

Publisher Copyright:
© 2016 Elsevier Inc.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

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