title: Rapid administration technique of ketamine for pediatric forearm fracture reduction: a dose-finding study.
abstract: OBJECTIVE
  We estimate the minimum dose and total sedation time of rapidly infused ketamine that achieves 3 to 5 minutes of effective sedation in children undergoing forearm fracture reduction in the emergency department.
  
  
  METHODS
  We used the up-down method to estimate the median dose of intravenous ketamine infused during less than or equal to 5 seconds that provided effective sedation in 50% (ED50) and 95% (ED95) of healthy children aged 2 to 5, 6 to 11, or 12 to 17 years who were undergoing forearm fracture reduction. Most patients were pretreated with opioids. Three investigators blinded to ketamine dose independently graded sedation effectiveness by viewing a video recording of the first 5 minutes of sedation. Recovery was assessed by modified Aldrete score.
  
  
  RESULTS
  We enrolled 20 children in each age group. The estimated ED50 was 0.7, 0.5, and 0.6 mg/kg and the estimated ED95 was 0.7, 0.7, and 0.8 mg/kg for the groups aged 2 to 5, 6 to 11, and 12 to 17 years, respectively. For the group aged 2 to 5 years, an empirically derived ED95 was 0.8 mg/kg. All patients who received the empirically derived ED95 in the group aged 2 to 5 years or the estimated ED95 in the groups aged 6 to 11 and 12 to 17 years had effective sedation. The median total sedation time for the 3 age groups, respectively, was 25, 22.5, and 25 minutes if 1 dose of ketamine was administered and 35, 25, and 45 minutes if additional doses were administered. No participant experienced serious adverse events.
  
  
  CONCLUSIONS
  We estimated ED50 and ED95 for rapidly infused ketamine for 3 age groups undergoing fracture reduction. Total sedation time was shorter than that in most previous studies.
authors.affiliation: Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO; St. Louis Children's Hospital, St. Louis, MO. Electronic address: srischinta@me.com.
authors.forename: Sri S
authors.initials: SS
authors.lastname: Chinta
authors.affiliation: Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO; St. Louis Children's Hospital, St. Louis, MO.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Schrock
authors.affiliation: Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO; St. Louis Children's Hospital, St. Louis, MO.
authors.forename: John D
authors.initials: JD
authors.lastname: McAllister
authors.affiliation: Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO; St. Louis Children's Hospital, St. Louis, MO.
authors.forename: David M
authors.initials: DM
authors.lastname: Jaffe
authors.affiliation: Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Jingxia
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO; St. Louis Children's Hospital, St. Louis, MO.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005543:Forearm Injuries / Q000628:therapy; D005592:Fracture Fixation; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male
chemical_list: D006993:Hypnotics and Sedatives; D007649:Ketamine