title: Prospective age-based comparison of behavioral reactions occurring after ketamine sedation in the ED.
abstract: The study objective was to prospectively evaluate the frequency and severity of behavioral reactions occurring in children receiving ketamine sedation in the emergency department (ED). A behavioral observational study was conducted. Ketamine was given in a standardized protocol with midazolam, atropine, and a prehypnotic suggestion. Descriptions of behavioral reactions were recorded immediately after the procedure, and longitudinal follow-up was made in 1 day, 1 week, and 1 month. A total of 301 patients were enrolled. Mild reactions described as not unpleasant occurred in 7/205 (3.4%, 95% CI 0.9-5.9%) of the younger age group, and 2/96 (2.1%, 95% CI 0-5.0%) of the older age group. Unpleasant reactions occurred in 2/205 (1.0%, 95% CI 0-2.4%) of the younger age group, and 4/96 (4.2%, 95% CI 0-8.2%) of the older age group. We observed no clinically important difference in the proportion of older versus younger children experiencing behavioral reactions after IV ketamine sedation.
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA. hostetler m@kids.wustl.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hostetler
authors.forename: Colleen O
authors.initials: CO
authors.lastname: Davis
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000293:Adolescent; D000367:Age Factors; D000762:Anesthesia Recovery Period; D000778:Anesthetics, Dissociative / Q000009:adverse effects*; D001285:Atropine / Q000008:administration & dosage; D002648:Child; D002652:Child Behavior / Q000187:drug effects* / Q000523:psychology; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects*; D004325:Dreams / Q000187:drug effects* / Q000523:psychology; D004359:Drug Therapy, Combination; D004638:Emergency Treatment / Q000009:adverse effects; D005260:Female; D006212:Hallucinations / Q000139:chemically induced* / Q000523:psychology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D007649:Ketamine / Q000009:adverse effects*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000759:Adjuvants, Anesthesia; D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine; D001285:Atropine; D008874:Midazolam