title: A retrospective comparison of ketamine dosing regimens for pediatric procedural sedation.
abstract: OBJECTIVE
  Ketamine is a dissociative agent often used in pediatric emergency departments for procedural sedation. Institutions commonly use either 1.5 mg/kg (k1.5) or 1 mg/kg (k1.0) as intravenous dosing. We sought to determine whether patients receiving k1.0 require more administered doses during sedation than patients receiving k1.5. Furthermore, we examined whether differences existed between k1.0 and k1.5 in the total dosage, total mg/kg, and time to recovery.
  
  
  METHODS
  A retrospective chart review examining procedural sedations from July 2010 through December 2011 was performed for sedations using k1.0 or k1.5. Cohorts were compared on the basis of the number of doses, mg/kg administered, total dosage (mg), and adverse events.
  
  
  RESULTS
  A total of 346 patients were included, with 159 patients in k1.0 and 187 patients in k1.5. No significant differences in demographics were observed between k1.0 and k1.5. Patients in k1.5 required fewer median doses of ketamine compared with k1.0 (1.0 vs. 2.0, P=0.02). k1.0 had a higher median overall mg/kg dosage (1.71 mg/kg) than k1.5 (1.60 mg/kg) (P<0.01). k1.5 showed a decrease in the number of sedations requiring a third dose of ketamine to complete sedation as compared with k1.0 (7.57 vs. 18.47%, P=0.002). No significant difference in adverse events was found between k1.0 and k1.5.
  
  
  CONCLUSIONS
  Sedations using k1.5 require fewer doses, lower mg/kg administered, but a higher total dose than k1.0. No difference was found in the rate of adverse events between the groups. Our findings suggest that ketamine sedations can be completed safely with one dose when patients are initially dosed at 1.5 mg/kg.
authors.affiliation: aDepartment of Pediatrics, Section of Pediatric Emergency Medicine, Comer Children's Hospital, The University of Chicago Medicine, Chicago, Illinois bDepartment of Pediatrics, Division of Emergency and Transport Medicine, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Heilbrunn
authors.forename: Todd P
authors.initials: TP
authors.lastname: Chang
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Liu
mesh_terms: D000367:Age Factors; D000777:Anesthetics / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D061214:Patient Safety / Q000706:statistics & numerical data; D010372:Pediatrics / Q000458:organization & administration; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D007649:Ketamine