I'm glad someone spoke up about this. Who are people kidding that they use Ketamine every shift but never even see a desaturation? For my part, I find children desaturate less now that I've stopped using versed with my ketamine sedations in kids < 10y/o. Also, I like being able to give versed for the rare emergence reaction, which in my experience works much better if the pt did not receive it with the initial sedation. But clearly, the idea that ketamine or other moderate sedation medications are adverse event free is not supported either by experience or the literature.
James Reingold, M.D.
Banner Desert Medical Center, Phoenix> Date: Mon, 11 Feb 2008 16:26:33 -0600> From: [log in to unmask]> Subject: Ketamine and adverse events> To: [log in to unmask]> > I completely agree that ketamine is a very safe and effective drug for ED> sedation. However, I am troubled by posts to this list that state “never> seeing adverse event x, y, or z” associated with specific drugs. All> patients who receive sedation drugs are at risk for experiencing adverse> events. (1,2) Patients who receive ketamine will experience adverse events> such as oxygen desaturations, apnea, laryngospasm, vomiting, and emergence> reactions (agitation). Those who administer sedation must be prepared to> manage adverse events. A partial list of studies that report sedation> (predominantly ketamine)-associated adverse events is listed below. (3-16)> > > > Mark Roback> > Pediatrics & Emergency Medicine > > University of Minnesota Medical School> > > > 1. Coté CJ, Notterman DA, Karl HW, et. al. Adverse sedation events in> pediatrics: a critical incident analysis of contributing factors.> Pediatrics 2000;106:633-644.> > 2. Coté CJ, Karl HW, Notterman DA, et. al. Adverse sedation events in> pediatrics: analysis of medications used for sedation. Pediatrics> 2000;105:805-814.> > 3. Green SM, Rothrock SG, Lynch EL, et al: Intramuscular ketamine for> pediatric sedation in the emergency department: safety profile in 1,022> cases. Ann Emerg Med 1998;31:6:688-697. > > 4. Green SM, Kuppermann N, Rothrock SG et al. Predictors of adverse> events with intramuscular ketamine sedation in children. Ann Emerg Med> 2000;35:35-42.> > 5. Kennedy RM, Porter FL, Miller JP et al: Comparison of> fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic> emergencies. Pediatr 1998;102:956-963> > 6. Wathen J, Bothner JP, Roback MG: Does midazolam alter the clinical> effects of intravenous ketamine sedation in children- a double blind,> prospective, emergency department report. Ann Emer Med. 2000;36:579-588. > > 7. Sherwin TS, Green SM, Khan A et al: Does adjunctive midazolam reduce> recovery agitation after ketamine sedation for pediatric procedures? A> randomized, double-blind, placebo-controlled trial. Annals of Emerg. Med.> 2000;35:3:229-238.> > 8. Roback MG, Wathen JE, Mackenzie T, Bajaj L. A Randomized, Controlled> Trial of IV vs. IM Ketamine for Sedation of Pediatric Patients Receiving> Emergency Department Orthopedic Procedures. Ann Emerg Med. 2006;48:605-612.> > 9. Roback MG, Wathen JE, Bajaj L, Bothner JP. Adverse Events> Associated with Procedural Sedation and Analgesia in a Pediatric Emergency> Department: A Comparison of Common Parenteral Drugs. Acad Emerg Med.> 2005;12:508-513.> > 10. Cravero JP, Blike GT, Beach M, et al. Incidence and nature of adverse> events during pediatric sedation/anesthesia for procedures outside the> operating room: report from the Pediatric Sedation Research Consortium.> Pediatrics 2006;118:1087-96.> > 11. Pitetti RD, Singh S, Clyde Pierce, M. Safe and efficacious use of> procedural sedation and analgesia by nonanesthesiologists in a pediatric> emergency department. Arch Pediatr Adol Med. 2003;157:1090-1096> > 12. Newman DH, Azer MM, Pitetti RD, et al. When is a patient safe for> discharge after procedural sedation? The timing of adverse effect events in> 1,367 pediatric procedural sedations. Ann Emerg Med 2003;42:627-35.> > 13. Pena BMG, Krauss B. Adverse events of procedural sedation and analgesia> in a pediatric emergency department. Ann Emerg Med 1999;34:483-491.> > 14. Agrawal D, Manzi SF, Gupta R et al. Preprocedural fasting state and> adverse events in children undergong procedural sedation and analgesia in a> pediatric emergency deparment. Ann Emerg Med. 2003;42:636-646.> > 15. Roback MG, Bajaj LB, Wathen J, et. al. Preprocedural Fasting and> Adverse Events in Procedural Sedation and Analgesia in a Pediatric Emergency> Department – Are They Related? Ann Emerg Med 2004;44:454-459.> > 16. Babl FE, Puspitadewi A, Barnett P et al. Preprocedural fasting state> and adverse events in children receiving nitrous oxide for procedural> sedation and analgesia. Pediatr Emerg Care. 2005;21:736-743.> > 17. > > > > -----Original Message-----> From: Pediatric Emergency Medicine Discussion List> [mailto:[log in to unmask]] On Behalf Of William Gibson> Sent: Monday, February 11, 2008 1:10 PM> To: [log in to unmask]> Subject: Re: ketamine for LP in ER> > > > I have reviewed the available literature on ketamine. I have never read nor> > > witnessed paradoxical excitation nor decreased respiratory efforts after > > it's use.; Does anyone have a reference for these assertions?> > > > Wm Gibson MD, FACEP> > ----- Original Message ----- > > From: "Dr Saeed Alobeidani" <[log in to unmask]>> > To: <[log in to unmask]>> > Sent: Monday, February 11, 2008 5:18 AM> > Subject: Re: ketamine for LP in ER> > > > > > > Thanks to all,> > > Medazolam is good to keep child sedated but there is the risk of > > > paradoxical> > > excitation and decrease respiratory efforts after procedure.> > > > > > ketamine has analgesic and amnesic effect.> > > Having no problem with doing the procedure doesn't mean the child and> > > parents are satisfied about it.> > > We had instance of parents refusing to continue the procedure because of> > > child's continous crying.> > > ketamine will be the drug of choice to keep everybody happy.> > > > > > In Advanced PEM conference in NY last year there was a talk that argued> > > about the scientific basis of not using ketamine for head injury pt.> > > > > > > > > Saeed Alobeidani> > > Royal hospital> > > > > > For more information, send mail to [log in to unmask] with the > > > message: info PED-EM-L> > > The URL for the PED-EM-L Web Page is:> > > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html> > > > > > > For more information, send mail to [log in to unmask] with the> message: info PED-EM-L> > The URL for the PED-EM-L Web Page is:> > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html> > > For more information, send mail to [log in to unmask] with the message: info PED-EM-L> The URL for the PED-EM-L Web Page is:> http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
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