Intramuscular ketamine is superior to meperidine, promethazine, and chlorpromazine for pediatric emergency department sedation.
OBJECTIVE
To compare ketamine hydrochloride (KET) with combined meperidine hydrochloride, promethazine hydrochloride, and chlorpromazine hydrochloride (MPC) for pediatric emergency department sedation with respect to onset, duration, and efficacy.


METHODS
Prospective, randomized, double-blind clinical trial.


METHODS
Pediatric emergency department in an urban university hospital.


METHODS
Convenience sample of 29 patients, 6 months to 6 years of age, requiring sedation for suturing, wound or burn debridement, or lumbar puncture.


METHODS
Children received intramuscular KET (4 mg/kg) with atropine sulfate (0.01 mg/kg) or MPC (meperidine hydrochloride 2 mg/kg, promethazine hydrochloride 1 mg/kg, chlorpromazine hydrochloride 1 mg/kg). Data collection included demographics, vital signs, and onset of sedation; procedural distress using the Observational Scale of Behavioral Distress; and time to recovery. The operator was questioned on satisfaction with the drug, and parents received follow-up to assess parental satisfaction.


RESULTS
Of the 29 patients enrolled in the study, 2 were excluded for protocol violation, 15 received KET, and 12 received MPC. Demographics and baseline vital signs did not differ. Although patients in the 2 groups had a similar duration of sedation (KET, 82 min vs MPC, 97 min, P = .15), patients receiving KET had more rapid onset of sedation (3 min vs 18 min, P < .01) a shorter time to discharge (85 min vs 113 min, P 0 .01) and lower Observational Scale of Behavioral Distress scores (9.9 vs 19.2, P = .003). All 15 physicians using KET would request it again vs 5 of 12 (42%) of the physicians using MPC (P < .001). No serious adverse reactions occurred. There were no differences in parental satisfaction.


CONCLUSIONS
Ketamine has a faster onset and results in more rapid discharge from the pediatric emergency department while providing for less patient distress during procedures. Ketamine is also associated with greater physician satisfaction than MPC.
Petrack
E M
EM
Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
Marx
C M
CM
Wright
M S
MS
D002648:Child; D002675:Child, Preschool; D002746:Chlorpromazine / Q000009:adverse effects; D016292:Procedural Sedation; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008614:Meperidine / Q000009:adverse effects; D017060:Patient Satisfaction; D011398:Promethazine / Q000009:adverse effects; D011446:Prospective Studies
D007649:Ketamine; D008614:Meperidine; D011398:Promethazine; D002746:Chlorpromazine