Question for the group regarding procedural sedation in the Pediatric ED setting specifically involving ketamine:
I'm sure most of you have seen the 2011 update to the Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation by Drs Green, Roback, Kennedy, and Krauss, that ran in the May edition of Annals EM (abstract below) in which the authors treat the unique qualities of ketamine as an agent distinct from the conventional dose-dependent sedation continuum and thus argue for a specific dissociative sedation classification.
This assertion was referenced without contention by Drs Cravero and Havidich in a review article on Pediatric Sedation that ran in Pediatric Anesthesia (abstract below).
Have any of your groups navigated and/or successfully developed a dissociative sedation classification for procedural sedation with ketamine in your emergency department? If not, how are you classifying ketamine sedations? (Question mirrored on Pediatric Sedation listserv)
Please respond to the list or to me personally. Thanks so much.
Benjamin F. Jackson, MD, FAAP
Assistant Professor of Pediatrics
Pediatric Emergency Medicine
Medical University of South Carolina
135 Rutledge Avenue, PO Box 250566
Charleston, SC 29425
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Ann Emerg Med. 2011 May;57(5):449-61. Epub 2011 Jan 21.
Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update.
Green SM, Roback MG, Kennedy RM, Krauss B.
SourceDepartment of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA 92354, USA.
We update an evidence-based clinical practice guideline for the administration of the dissociative agent ketamine for emergency department procedural sedation and analgesia. Substantial new research warrants revision of the widely disseminated 2004 guideline, particularly with respect to contraindications, age recommendations, potential neurotoxicity, and the role of coadministered anticholinergics and benzodiazepines. We critically discuss indications, contraindications, personnel requirements, monitoring, dosing, coadministered medications, recovery issues, and future research questions for ketamine dissociative sedation.
Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
PMID: 21256625 [PubMed - indexed for MEDLINE]
Paediatr Anaesth. 2011 Jul;21(7):800-9. doi: 10.1111/j.1460-9592.2011.03617.x. Epub 2011 May 18.
Pediatric sedation--evolution and revolution.
Cravero JP, Havidich JE.
SourceDepartment of Anesthesiology, Dartmouth Medical School/Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA. [log in to unmask]
Pediatric sedation continues to change in terms of the professionals who provide this care, those who produce original research on this topic, guidelines and literature concerning risk, medications employed, and methods for training for new providers. Some of the changes could be categorized as 'evolutionary' or gradual in nature and predictable - such as the changing role of anesthesiologists in the field of pediatric sedation and the use of the well-established dissociative sedative, ketamine. Other changes in pediatric sedation are more radical or 'revolutionary'. They include reconsideration of what is defined as an 'adverse event' during sedation, the use of propofol or dexmedetomidine, and the application of human patient simulation for training. This review will highlight the ongoing changes in the dynamic field of pediatric sedation by focusing on some of the important progress (both evolutionary and revolutionary) that has occurred across the varied specialties that provide this care.
© 2011 Blackwell Publishing Ltd.
PMID: 21585616 [PubMed - indexed for MEDLINE]
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