Evolution of a protocol for ketamine-induced sedation as an alternative to general anesthesia for interventional radiologic procedures in pediatric patients.
OBJECTIVE
To establish a protocol for credentialed pediatric radiology nurses, with radiologist supervision, to administer ketamine to induce sedation and analgesia during interventional radiologic procedures.


METHODS
This study was conducted in two phases. The goal of the first phase was to develop a sedation protocol to replace that of using general anesthesia for specified pediatric interventional procedures. Ketamine was administered intravenously (with intermittent bolus or continuous infusion) or intramuscularly. Sedation induction times, adverse events, doses, and sedation and recovery durations were recorded. In phase 2, the results of phase 1 were reviewed and a formal ketamine protocol was developed.


RESULTS
Neither sedation failures nor substantial adverse events occurred in phase 1. Mean duration of all sedations was 52 minutes, and median recovery room time was 0 minutes. In phase 2, the results of phase 1 were reviewed and a sedation protocol was proposed to a hierarchy of hospital committees before final approval from the medical staff executive committee. Subsequently, standard order forms for radiology nurse administration of ketamine with radiologist supervision were prepared for exclusive use by the pediatric interventional radiology department.


CONCLUSIONS
Ketamine-induced sedation may be a safe and effective alternative to general anesthesia for some interventional radiologic procedures in pediatric patients. Collaboration between anesthesia and radiology departments is important for development of a safe and successful ketamine sedation program. To the authors' knowledge, this is the first report describing the intravenous infusion of ketamine for sedation in pediatric patients and the only report describing the establishment of a protocol for ketamine administration by credentialed radiology nurses with radiologist supervision.
Mason
Keira P
KP
Department of Anesthesia, The Children's Hospital, 300 Longwood Ave, Boston, MA 02115-5737, USA. keira.mason@tch.harvard.edu
Michna
Edward
E
DiNardo
James A
JA
Zurakowski
David
D
Karian
Victoria E
VE
Connor
Linda
L
Burrows
Patricia E
PE
D000293:Adolescent; D016907:Adverse Drug Reaction Reporting Systems; D000768:Anesthesia, General / Q000451:nursing; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000451:nursing; D003406:Credentialing; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007273:Injections, Intramuscular; D007649:Ketamine / Q000009:adverse effects; D008297:Male; D009730:Nursing Assessment; D009934:Organization and Administration; D010348:Patient Care Team; D010371:Pediatric Nursing / Q000193:education; D011872:Radiology Department, Hospital; D015642:Radiology, Interventional / Q000379:methods
D007649:Ketamine