Low-dose ketamine: efficacy in pediatric sedation.
OBJECTIVE
Intravenous (IV) ketamine has gained widespread use in the emergency department (ED) for procedural sedation. The most commonly recommended starting dose is 1.5 mg/kg. We examined whether lower doses of ketamine in the range of 0.5 to 1.0 mg/kg could successfully sedate pediatric patients.


METHODS
We retrospectively reviewed quality assurance data of patients sedated with IV ketamine in a pediatric ED. Patients were administered 0.02 mg/kg of IV atropine, 0.05 mg/kg of IV midazolam, and then 0.5 mg/kg of IV ketamine. Additional aliquots of 0.25 to 0.5 mg/kg of ketamine were given as necessary, to a maximum of 2.0 mg/kg. Efficacy of sedation was assessed after every dose by pediatric emergency medicine attendings or fellows.


RESULTS
Seventy-two patients had quality assurance forms completed. The total ketamine dose administered ranged from 0.5 to 2 mg/kg. Adequate procedural sedation was obtained for 70 (97%) of 72 patients. Forty-four percent of patients required 0.75 mg/kg or less of ketamine to obtain adequate initial sedation; 25% of subjects required only 0.5 mg/kg; 43% of patients required 1.0 mg/kg of IV ketamine. We found that 88% of our patients could be successfully sedated at initial doses of 1 mg/kg or less.


CONCLUSIONS
Our study suggests a potential role for low-dose IV ketamine in the range of 0.5 to 1.0 mg/kg for pediatric procedural sedation. Most pediatric ED patients can be successfully sedated with 1 mg/kg of ketamine.
Bleiberg
Alan H
AH
Department of Pediatrics, University of Texas Southwestern Medical Center Dallas, TX 75235, USA. Alan.Bleiberg@Childrens.com
Salvaggio
Christy A
CA
Roy
Lonnie C
LC
Kassutto
Zach
Z
D000293:Adolescent; D001285:Atropine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D000860:Hypoxia / Q000139:chemically induced; D007223:Infant; D007275:Injections, Intravenous; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced; D008874:Midazolam / Q000008:administration & dosage; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014839:Vomiting / Q000139:chemically induced
D006993:Hypnotics and Sedatives; D007649:Ketamine; D001285:Atropine; D008874:Midazolam