title: Use of continuous intravenous ketamine for end-stage cancer pain in children.
abstract: Children in the terminal stage of cancer may experience intractable pain despite the use of high doses of opioids. The resultant sedating effect of the opioids limits the child's ability to communicate and participate in activities, thereby negatively affecting quality of life. Ketamine, an intravenous (IV) anesthetic with analgesic properties, when used in low doses, may be useful in managing pediatric cancer pain at the end of life. Ketamine can prevent the development of opioid tolerance and provide additional analgesia without an increase in sedating effects. At the authors' institution, 2 children with end-stage cancer were started on continuous infusion low-dose ketamine to help achieve adequate pain control and allow the children to be home and interactive for the last weeks of their lives. Each case illustrates the complexities of achieving and maintaining adequate pain control and promoting care of the child and family in a setting that is most appropriate for them.
authors.affiliation: Hematology-Oncology Division at Connecticut Children's Medical Center, Hartford 06106, USA. mxconway@ccmckids.org
authors.forename: Mary
authors.initials: M
authors.lastname: Conway
authors.forename: Natalie
authors.initials: N
authors.lastname: White
authors.forename: Candie St
authors.initials: CS
authors.lastname: Jean
authors.forename: William T
authors.initials: WT
authors.lastname: Zempsky
authors.forename: Katherine
authors.initials: K
authors.lastname: Steven
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009369:Neoplasms / Q000150:complications*; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D013727:Terminal Care
chemical_list: D000700:Analgesics; D007649:Ketamine