title: Ketamine sedation is not associated with clinically meaningful elevation of intraocular pressure.
abstract: BACKGROUND
  Ketamine is widely used for procedural sedation, but there is limited knowledge on whether ketamine use is associated with elevated intraocular pressure (IOP).
  
  
  OBJECTIVE
  The aim of this study was to examine whether there are clinically important elevations of IOP associated with ketamine use during pediatric procedural sedation.
  
  
  METHODS
  We prospectively enrolled children without ocular abnormalities undergoing procedural sedation that included ketamine for nonperiorbital injuries. We measured IOP for each eye before and at 1, 3, 5, 15, and 30 minutes after initial intravenous ketamine administration. We performed Bland-Altman plots to determine if IOP measurements in both eyes were in agreement. Linear regression was used to model the mean IOP of both eyes as a function of time, dose, and age, with a robust sandwich estimator to account for repeated measures.
  
  
  RESULTS
  Among 25 participants, median (interquartile range) age was 11 (9-12) years, and 18 (72%) were male. Median ketamine dose was 1.88 mg/kg (interquartile range, 1.43-2.03 mg/kg; range 0.96-4 mg/kg). Bland-Altman plots demonstrated a mean difference of IOP between eyes near zero at all time points. The largest predicted difference from baseline IOP occurred at 15 minutes, with an estimated change of 1.09 mm Hg (95% confidence interval, -0.37 to 2.55). The association between ketamine dose and mean IOP was not statistically significant or clinically meaningful (P = .90; estimated slope, 0.119 [95% confidence interval, -1.71 to 1.95]). There were no clinically meaningful levels of increased measured average IOP reached at any time point.
  
  
  CONCLUSIONS
  At dosages of 4 mg/kg or less, there are not clinically meaningful associations of ketamine with elevation of IOP.
authors.affiliation: Pediatric Emergency Medicine, Vanderbilt Children's Hospital, Nashville, TN 37232-9001, USA. patrick.c.drayna@vanderbilt.edu
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Drayna
authors.forename: Cristina
authors.initials: C
authors.lastname: Estrada
authors.forename: Wenli
authors.initials: W
authors.lastname: Wang
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Saville
authors.forename: Donald H
authors.initials: DH
authors.lastname: Arnold
mesh_terms: D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000009:adverse effects*; D002648:Child; D016292:Procedural Sedation / Q000009:adverse effects*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D007649:Ketamine / Q000009:adverse effects*; D008297:Male; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine