title: Optimal dosing of intravenous ketamine for procedural sedation in children in the ED-a randomized controlled trial.
abstract: OBJECTIVE
  The objective of the study is to compare need for redosing, sedation efficacy, duration, and adverse events between 3 commonly administered doses of parenteral ketamine in the emergency department (ED).
  
  
  METHODS
  We conducted a prospective, double-blind, randomized controlled trial on a convenience sample of children 3 to 18years who received intravenous ketamine for procedural sedation. Children from each age group (3-6, 7-12, and 13-18years) were assigned in equal numbers to 3 dosing groups (1, 1.5, and 2mg/kg) using random permuted blocks. The primary outcome measure was need for ketamine redosing to ensure adequate sedation. Secondary outcome measures were sedation efficacy, sedation duration, and sedation-related adverse events.
  
  
  RESULTS
  A total of 171 children were enrolled of whom 125 (1mg/kg, 50; 1.5mg/kg, 35; 2mg/kg, 40) received the randomized dose and were analyzed. The need for ketamine redosing was higher in the 1mg/kg group (8/50; 16.0% vs 1/35; 2.9% vs 2/40; 5.0%). There was no significant difference in the median Ramsay sedation scores (5.5 [interquartile range {IQR}, 4-6] vs 6 [IQR, 4-6] vs 6 [IQR, 5-6]), FACES-R score (0 [IQR, 0-4] vs 0 [IQR, 0-0] vs 0 [IQR, 0-0]), sedation duration in minutes (23 [IQR, 19-38] vs 24.5 [IQR, 17.5-34.5] vs 23 [IQR, 19-29]), and adverse events (10.0% vs 14.3% vs 10.0%) between the 3 dosing groups. Physician satisfaction was lower in the 1mg/kg group (79.6% vs 94.1% vs 97.3%).
  
  
  CONCLUSIONS
  Adequate sedation was achieved with all 3 doses of ketamine. Higher doses did not increase the risk of adverse events or prolong sedation. Ketamine administered at 1.5 or 2.0mg/kg intravenous required less redosing and resulted in greater physician satisfaction.
authors.affiliation: Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI 48201. Electronic address: nkannike@dmc.org.
authors.forename: Nirupama
authors.initials: N
authors.lastname: Kannikeswaran
authors.affiliation: Wayne State University School of Medicine, Chicago, IL 60654; Accreditation Council for Graduate Medical Education, Chicago, IL 60654.
authors.forename: Mary
authors.initials: M
authors.lastname: Lieh-Lai
authors.affiliation: Department of Pharmacy Services, Children's Hospital of Michigan, Detroit, MI 48201.
authors.forename: Monica
authors.initials: M
authors.lastname: Malian
authors.affiliation: Wayne State University School of Medicine, Detroit, MI 48201.
authors.forename: Bo
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Farooqi
authors.affiliation: University of Minnesota Medical School, Minneapolis, MN 55455.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Roback
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D011446:Prospective Studies
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine