Intranasal ketamine satisfies doctors in the pediatric ED

  • Pediatr Emerg Care

  • International Clinical Digest
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Takeaway

  • Providers caring for children requiring analgesia in the pediatric emergency department (ED) found intranasal ketamine to be satisfactory and provide a high degree of perceived patient comfort.
  • The 3-4 mg/kg dosing range appeared to be the most effective.
  • Side effects were mild.

Why this matters

  • Few studies have examined the use of intranasal ketamine for children in the ED.

Key results

  • Median age, 3.8 years.
  • Median dose, 3.9 mg/kg.
  • Provider satisfaction, 90/100.
  • Provider perception of patient comfort, 75/100.
  • 7.7% (15) of patients experienced treatment failure requiring procedural sedation with other drugs.
  • The group experiencing treatment failure received a similar median dose to their counterparts (3.9 mg/kg).
  • 6% (12) of patients experienced adverse events, most commonly nausea.
  • 1 patient experienced dysphoria; they had received a dose >5 mg/kg.

Study design

  • Retrospective chart review of children aged 6 months to 18 years who received intranasal ketamine (n=196), plus a prospective survey of their providers.
  • Protocol called for initial dose of 2-5 mg/kg.
  • Outcome: provider satisfaction with intranasal ketamine for perceived patient pain, anxiolysis, and agitation, rated on 0-100 scale.
  • Funding: NIH.

Limitations

  • Small study without active comparator.
  • No details on, e.g., patient satisfaction, onset time, or duration of analgesia.