Introduction: Procedural sedation with Ketamine has become the popular choice in most pediatric emergency departments (PED) across the western world due to its safety and analgesic profile. However, Ketamine uptake across the PED’s in the Middle East has been slow.
Aims: Our study aimed to shed light on the safety profile of Ketamine based on our experience and to address some of the variability in current practice.
Methods: A two-year (January 2016 to December 2017) retrospective cross-sectional study of children <15 years of age who underwent procedural sedation with intravenous (IV) Ketamine was carried out. Data obtained from Electronic Medical Records (EMR). Exclusion criteria: ASA > 2, active respiratory infection, airways disease, < 6 months, pharyngeal procedures, Ketamine allergy & psychiatric disorder.
Results: 458 children had received IV Ketamine. 414 cases were accepted into the study. The mean age (SD) of our sample was 4.8 (3.1). The most common indication for sedation was laceration repair (80.7%), followed by fracture reduction (14.3%), and other procedures (5%). Out of our sample only 7 (1.7%) children had an adverse event out of which 6 had nausea & vomiting (85.7%) and 1 (14.3%) had bradycardia. The mean (SD) dose of ketamine used was 1.59 mg/kg (0.5). Correlation analyses indicate a relationship between the dose given and the side effect (r= -7.3, n= 7, p= 0.031). The mean (SD) of the procedural length (from injection to the time of discharge) was 115.4 (58.6) minutes. Out of our sample, 52 (12.5%) patients received antiemtics in total, therapeutic or prophylactic, and none of those patients receiving prophylactic had any episode of vomiting.
Conclusions: We conclude that modifying the dose of ketamine combined with prophylactic antiemetic could be an effective choice in pediatric procedural sedation with minimal side effects.