title: Ketamine Continuous Infusions in Critically Ill Infants and Children.
abstract: OBJECTIVE
  To review the role of ketamine continuous infusions (CINs) in critically ill children for sedation and analgesia, withdrawal, and bronchospasm.
  
  
  METHODS
  Relevant articles were identified using MEDLINE (1946 to December 2015), EMBASE (1988 to December 2015), International Pharmaceutical Abstracts (1970 to December 2015), and the Cochrane Library (1996 to December 2015) using the terms ketamine, children, and CIN.
  
  
  METHODS
  All English-language articles in humans identified from data sources were evaluated. Three studies and 8 case reports/series representing 74 patients were included.
  
  
  RESULTS
  Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that blocks glutamate in the limbic system, resulting in sedation and analgesia. Additionally, it provides bronchodilation by increasing catecholamine transmission and stimulation of β2 receptors. The majority of reports evaluated ketamine for bronchospasm in children with status asthmaticus or bronchospasm refractory to conventional treatments. A total of 72 patients (97.3%) received a loading dose ranging from 0.2 to 2 mg/kg prior to CIN initiation. The CIN dosing range was 0.2 to 3.6 mg/kg/h. Children who received ketamine for sedation or opioid withdrawal received a lower dose than children initiated on it for bronchospasm: 0.24 to 0.9 versus 0.2 to 3.6 mg/kg/h, respectively. Duration of use ranged from 1 to 96 hours. Six of the reports mentioned that the ketamine CIN was tapered prior to discontinuation. Approximately 10.8% of patients included in the analysis experienced adverse events, with only 3 children (4.1%) experiencing emergence phenomenon.
  
  
  CONCLUSIONS
  Limited evidence was noted, so ketamine CINs could be considered an adjunct therapy at this time. Further prospective studies should be conducted to determine ketamine's role in sedation and analgesia, withdrawal treatment, and bronchospasm treatment.
authors.affiliation: University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Golding
authors.affiliation: University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Miller
authors.affiliation: University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
authors.forename: Morris R
authors.initials: MR
authors.lastname: Gessouroun
authors.affiliation: University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA peter-johnson@ouhsc.edu.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Johnson
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D002648:Child; D016638:Critical Illness; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D007649:Ketamine
keywords: child; ketamine; opioid withdrawal; sedation