title: Intravenous ketamine sedation for painful oncology procedures.
abstract: BACKGROUND
  The aim of the study was to determine the efficacy and adverse effects of intravenous (i.v.) ketamine sedation administered by nonanesthetist physicians for painful procedures.
  
  
  METHODS
  A single-agent, procedural sedation protocol using titrated doses of ketamine i.v. (maximum 2 mg.kg(-1)) was conducted in outpatient pediatric oncology patients undergoing lumbar puncture (LP), bone marrow biopsy/aspiration (BMBx/A) or combination (LP/BMBx/A) in a tertiary care setting. The efficacy of analgesia and sedation (ability to perform the procedure), procedure duration, recovery time and the occurrence of adverse events are described.
  
  
  RESULTS
  Fifty-eight subjects of a median age of 5 years (1-13) and median weight of 20 kg (10.5-68) underwent 119 sedations. An LP was performed in 73% of cases, a BMBx/A in 13% and LP/BMBx/A in 13%. Efficacy was 100% and the mean dose of ketamine was 1.3 mg.kg(-1) (0.4). The mean duration of the procedure was 6.6 min (4.2) and the recovery time was 11 min (4-45). Two subjects (1.7%) had a hypoxemia (SpO2 of <94%). No major airway complications occurred. The prevalence of hypertension (systolic > 20% at 5 min) was 54%. The median pain visual analogue score (VAS) for an observer was 0 (range 0-3) and caregiver was 0 (range 0-4). The median VAS for satisfaction (observer) was 10 (range 7-10) and caregiver VAS was also 10 (range 5-10). At 24 h after discharge, the incidence of bad dreams was 3.3%; vomiting, 10.8%; and abnormal behavior, 4.2%.
  
  
  CONCLUSIONS
  Ketamine i.v. up to 2 mg.kg(-1) is an effective sedative for oncology procedures using a defined protocol.
authors.affiliation: Department of Anesthesiology, British Columbia Children's Hospital, University of British Columbia, Vanouver, BC, Canada.
authors.forename: Dan
authors.initials: D
authors.lastname: Evans
authors.forename: Lucy
authors.initials: L
authors.lastname: Turnham
authors.forename: Kathryn
authors.initials: K
authors.lastname: Barbour
authors.forename: Jeff
authors.initials: J
authors.lastname: Kobe
authors.forename: Laura
authors.initials: L
authors.lastname: Wilson
authors.forename: Christine
authors.initials: C
authors.lastname: Vandebeek
authors.forename: Carolyne J
authors.initials: CJ
authors.lastname: Montgomery
authors.forename: Paul
authors.initials: P
authors.lastname: Rogers
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use; D001707:Biopsy, Needle / Q000009:adverse effects; D001856:Bone Marrow Examination / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous / Q000379:methods; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008012:Lidocaine / Q000627:therapeutic use; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D011318:Prilocaine / Q000627:therapeutic use; D013129:Spinal Puncture / Q000009:adverse effects*; D013748:Tetracaine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D013748:Tetracaine; D007649:Ketamine; D008012:Lidocaine