title: Paediatric procedural sedation using ketamine in a UK emergency department: a 7 year review of practice.
abstract: BACKGROUND
  Ketamine is growing in popularity for procedural sedation in the paediatric population, yet safety concerns remain. We performed a retrospective review of practice and outcomes of paediatric ketamine sedation using the World SIVA International Sedation Task Force reporting tool.
  
  
  METHODS
  A retrospective inspection of the dedicated emergency department electronic sedation database and subsequent note and sedation chart review was performed for all paediatric sedations throughout a 7 yr period from September 2006. All adverse events were stratified.
  
  
  RESULTS
  During the study period, procedural sedation was provided for a total of 243 children, of whom 215 were sedated with ketamine, most commonly for wound management (n=131). The median patient age was 4 yr (14 months to 15 yr), and 63.7% were male. Of the total, 76.7% were discharged home either directly (n=101) or after brief observation (n=64). One patient required subsequent general anaesthesia after a failed sedation with paradoxical agitation. Of the total, 9.8% of patients had an adverse event, the most severe risk stratification being 'minor risk'. All interventions were 'minimal risk'. There were no 'sentinel risk' outcomes.
  
  
  CONCLUSIONS
  These data support the ongoing use of ketamine for paediatric procedural sedation in the emergency department by emergency physicians. Relatively high resource requirements mean that ensuring adequate numbers of procedures may prove challenging.
authors.affiliation: Department of Anaesthetics, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW lawrie.kidd@gmail.com.
authors.forename: L R
authors.initials: LR
authors.lastname: Kidd
authors.affiliation: Department of Anaesthetics, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW.
authors.forename: S C
authors.initials: SC
authors.lastname: Lyons
authors.affiliation: Emergency Department, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lloyd
mesh_terms: D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000009:adverse effects; D008297:Male; D010351:Patient Discharge; D011595:Psychomotor Agitation; D012189:Retrospective Studies; D006113:United Kingdom; D014947:Wounds and Injuries / Q000628:therapy
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine
keywords: adverse drug reaction reporting systems; anaesthetics, intravenous; emergency service, hospital; ketamine; sedation