title: Ketamine-based procedural sedation and analgesia for botulinum toxin A injections in children with cerebral palsy.
abstract: BACKGROUND
  Adequate procedural sedation and analgesia (PSA) is essential to reduce pain and distress for children undergoing intramuscular botulinum toxin (BoNT-A) injections. This study describes our institution's experience with ketamine-based PSA in terms of safety and efficacy in children with cerebral palsy receiving BoNT-A injections.
  
  
  METHODS
  This is an analysis of ketamine-based PSA for children undergoing BoNT-A injections between January 2000 and October 2014. All patients received PSA according to our institution's sedation protocol. From 2000 to 2012, intravenous ketamine and midazolam PSA was administered. From 2013 onwards, intravenous ketamine was used as a sole agent for PSA.
  
  
  RESULTS
  A total of 152 BoNT-A procedures were performed successfully on 87 children. The median age of the children was 5 years 5 months with 9 children younger than 36 months. Ten procedures (6.6%) were associated with acute transient self-limiting side effects: Four developed rashes, three had nausea and vomiting, one child had limb tremors and another child complained of mild headache. One child reported nightmares on the evening of the procedure during the two-week post-procedure review. No child experienced serious adverse events.
  
  
  CONCLUSIONS
  Administration of ketamine-based PSA for intramuscular BoNT-A procedures in children can be both safe and efficacious.
authors.affiliation: Neurology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore. Electronic address: cristelle.chow.ct@kkh.com.sg.
authors.forename: Cristelle
authors.initials: C
authors.lastname: Chow
authors.affiliation: Neurology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.
authors.forename: Chew Thye
authors.initials: CT
authors.lastname: Choong
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D009465:Neuromuscular Agents / Q000008:administration & dosage*
chemical_list: D009465:Neuromuscular Agents; D007649:Ketamine; D019274:Botulinum Toxins, Type A; D008874:Midazolam
keywords: Botulinum toxin; Cerebral palsy; Children; Ketamine; Procedural sedation