title: Ketamine sedation for children in the emergency department.
abstract: OBJECTIVE
  To introduce a protocol for dissociative sedation using ketamine for children requiring painful procedures within the emergency department.
  
  
  METHODS
  A medical literature search was performed along with a review of existing ketamine-use protocols in emergency departments from Australia and the United States. Our hospital anaesthetic department and our emergency department nursing staff were closely involved in protocol design. A series of nursing education sessions were held prior to the drug being used within the emergency department. Twenty-eight children aged 1.5-12 years were administered ketamine sedation prior to undergoing a painful procedure. Ketamine was administered either i.m. (dose 3-4 mg/kg) or i.v. (dose 1.00-2.75 mg/kg) depending on physician preference. Midazolam (dose 0.02 mg/kg) and atropine (dose 0.02 mg/kg) were given as adjuncts in the majority of cases.
  
  
  RESULTS
  Onset of sedation was rapid (range 1-7 min) for both routes and provided excellent procedural conditions. Discharge time averaged 103 min (range 67-180 min) from time of drug administration. Side-effects included vomiting, rash, diplopia, salivation and one case of a distressing emergence reaction. On telephone follow up 1-3 days after the sedation, no delayed adverse events were reported.
  
  
  CONCLUSIONS
  Ketamine is a safe and effective sedative agent for use in children requiring immobilization to enable performance of a painful procedure. It is important to involve both anaesthetic staff and emergency department nursing staff in sedation protocol development to ensure a smooth introduction. We present a protocol for ketamine use in children undergoing painful procedures within the emergency department.
authors.affiliation: Department of Emergency Medicine, Sunshine Hospital, Melbourne, Victoria, Australia. priests@nwhcn.org.au
authors.forename: S J
authors.initials: SJ
authors.lastname: Priestley
authors.forename: J
authors.initials: J
authors.lastname: Taylor
authors.forename: C M
authors.initials: CM
authors.lastname: McAdam
authors.forename: P
authors.initials: P
authors.lastname: Francis
mesh_terms: D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001285:Atropine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004638:Emergency Treatment; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008874:Midazolam / Q000627:therapeutic use; D009741:Nursing Staff, Hospital / Q000193:education; D010865:Pilot Projects; D017751:Safety Management / Q000458:organization & administration*; D014739:Victoria; D014947:Wounds and Injuries / Q000601:surgery
chemical_list: D000759:Adjuvants, Anesthesia; D000778:Anesthetics, Dissociative; D007649:Ketamine; D001285:Atropine; D008874:Midazolam