title: A fixed-dose ketamine protocol for adolescent sedations in a pediatric emergency department.
abstract: OBJECTIVE
  To assess provider and patient satisfaction with a fixed-dose ketamine protocol for procedural sedation of adolescent subjects. We further compared data for normal weight (body mass index [BMI] ≤ 25 kg/m(2)) vs overweight/obese subjects (BMI >25 kg/m(2)).
  
  
  METHODS
  Prospective, observational cohort study of adolescent patients undergoing procedural sedation in a pediatric emergency department. Adequate sedation was defined as a Ramsay Sedation Score (RSS) ≥ 5. Subjects received an initial 50 mg intravenous ketamine dose followed by 25 mg intravenous doses to maintain an RSS ≥ 5. The sedating physician, procedural physician, and sedating nurse independently rated the sedations on a 100 mm visual analog scale (0 = "very unsatisfied", 100 = "very satisfied"). Subjects and their guardians were contacted 12-24 hours postsedation.
  
  
  RESULTS
  Forty-three subjects (26 normal weight, 17 overweight/obese), aged 12-17 years, were enrolled in the study. An RSS ≥ 5 was observed in 35 (81.4%) of the subjects following the initial 50 mg ketamine dose and in the remaining 8 subjects following the first additional 25 mg dose. The median combined provider satisfaction score for the sedations was 92.7 (IQR 83.7-95.0) and was similar for the normal weight and overweight/obese groups (93.1 [IQR 84.6-95.9] vs 89.7 [IQR 83.7-93.5], respectively, P = .27). Subjects and guardians in both groups reported high rates of satisfaction.
  
  
  CONCLUSIONS
  The fixed-dose ketamine protocol resulted in an adequate level of sedation and high provider/patient satisfaction for the majority of patients regardless of weight or BMI status.
authors.affiliation: Department of Pediatric Emergency Medicine, University of Texas Southwestern School of Medicine and Children's Medical Center of Dallas, Dallas, TX.
authors.forename: Megan H
authors.initials: MH
authors.lastname: Street
authors.affiliation: Department of Pediatrics, Saint Louis University School of Medicine and SSM Cardinal Glennon Children's Medical Center, St. Louis, MO.
authors.forename: James M
authors.initials: JM
authors.lastname: Gerard
mesh_terms: D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000008:administration & dosage*; D015992:Body Mass Index; D002648:Child; D002985:Clinical Protocols; D054810:Deep Sedation; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D009765:Obesity; D050177:Overweight; D017060:Patient Satisfaction; D010372:Pediatrics; D011446:Prospective Studies
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine