Ketamine sedation for pediatric critical care procedures

Objectives: To describe our experience using ketamine sedation to facilitate pediatric critical care procedures, and to document the safety profile of ketamine in this setting. Design: Retrospective consecutive case series. Setting: Pediatric intensive care unit of a tertiary children's hospital. Patients: Children receiving ketamine for procedural sedation over a 5-year period. Interventions: We reviewed patient records to determine indication, dosing, adverse events, inadequate sedation, and recovery time for each sedation. Outcome Measures: Descriptive features of sedation including adverse events. Results: During the study period, children in our pediatric intensive care unit received ketamine at total of 442 times to facilitate a wide variety of critical care procedures, most commonly central line placement, esophagogastroduodenoscopy, and wound debridement. Most study children had substantial underlying illness (ASA ≥ 3 in 88%; ASA ≥ 4 in 39%). Inadequate sedation was noted in only nine (2%) procedures. Adverse effects included transient laryngospasm (n = 9), transient partial airway obstruction (n = 5), apnea with bradycardia (n = 1), emesis during the procedure (n = 2), emesis during recovery (n = 9), mild recovery agitation (n = 10), moderate-to-severe recovery agitation (n = 1), and excessive salivation (n = 4). There were no adverse outcomes attributable to ketamine. Conclusion: Pediatric intensivists skilled in ketamine administration can safely and effectively administer this drug to facilitate critical care procedures. Despite the ill nature of our patient sample, adverse effects were uncommon.