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PED-EM-L  February 2015

PED-EM-L February 2015

Subject:

Re: ketamine

From:

Mike Falk <[log in to unmask]>

Reply-To:

Mike Falk <[log in to unmask]>

Date:

Wed, 18 Feb 2015 20:18:42 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (142 lines)

Just to clarify, was not asking about procedural sedation.  Just in use the setting of trauma/rsi....thanks for the feedback.  Was very helpful.
Mike 

Sent from my iPhone

> On Feb 18, 2015, at 19:30, Krieser, David <[log in to unmask]> wrote:
> 
> Dear Mike et al
> 
> In Melbourne, ketamine is the major parenteral sedative.  Safe and very efficacious.  Two papers from Australia below.
> 
> Regards
> 
> David
> 
> 
> 
> 
> Procedural sedation in children in the emergency department: A PREDICT study
> 
> EMA 2009; 21: 719
> 
> Meredith Borland,1 Amanda Esson,1 Franz Babl,2,3 and David Krieser4
> 1Princess Margaret Hospital, Perth, Western Australia, 2Royal Children’s Hospital, Melbourne, 3Murdoch Children’s Research Institute, University of Melbourne, Melbourne, 4Sunshine Hospital, Melbourne, Victoria, Australia
> 
> ABSTRACT
> 
> Objective:
> 
> To investigate current procedural sedation practice and compare clinical practice guide- lines (CPG) for procedural sedation at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. This will determine areas for improvement and provide baseline data for future multicentre studies.
> 
> Methods:
> 
> A questionnaire of specialist emergency physicians regarding demographics, general pro- cedural sedation practice and specific sedation agents given to children. CPG for general sedation and sedation agents were obtained for each site.
> 
> Results:
> 
> Seventy-five (71%) useable surveys returned from 105 potential respondents. Most com- monly used agents were nitrous oxide (N2O) (75, 100%), ketamine (total 72, 96%; i.v. 59, 83% and i.m. 22, 31%) and midazolam (total 68, 91%; i.v. 52, 81%, oral 47, 73%, intranasal 26, 41% and i.m. 6, 9%). Sedation was used for therapeutic and diagnostic procedures. Forty-three (57%) used formal sedation records and sedation checklists and thirty-one (41%) respondents reported auditing sedations. Four sites ran staff education and compe- tency programmes. Nine sites had general sedation CPG, eight for ketamine, nine for N2O, eight for midazolam (four parenteral, five oral and six intranasal) and three for fentanyl. No site had a guideline for propofol administration.
> 
> Conclusion:
> 
> Procedural sedation in this research network commonly uses N2O, ketamine and mida- zolam for a wide range of procedures. Areas of improvement are the lack of guidelines for certain agents, documentation, staff competency training and auditing processes. Multi- centre research could close gaps in terms of age cut-offs, fasting times and optimal indications for various agents.
> 
> 
> Paediatric procedural sedation based on nitrous oxide and ketamine: sedation registry data from Australia
> 
> EMJ 2009; doi:10.1136/emj.2009.084384
> 
> Franz E Babl,1,2,3 Julie Belousoff,1 Conor Deasy,1 Sandy Hopper,1,2,3 Theane Theophilos1,2
> 
> ABSTRACT
> Objective
> 
> Large, mainly North American, series has shown the safety of paediatric procedural sedation in the emergency department (ED). However, sedation practices elsewhere differ. This study set out to investigate the sedation practice and the associated adverse events profile at the largest Australian paediatric ED.
> Method
> 
> Review of a prospective single centre procedural sedation registry database at an urban tertiary children’s hospital ED in Australia with an annual census of 67 000 patients over a 4-year period (2004e8). Sedation records were supplemented with medical record review. Patients 18 years and older were excluded. Demographics, agents used, adverse events and complications were analysed descriptively.
> Results
> 
> Over the 4-year period, 2002 patients underwent procedural sedation. The median age was 5.7 years. Nitrous oxide was used in 1625 (81%), ketamine in 335 (17%) and midazolam in 39 (2%). Propofol and chloral hydrate were used in two and one patient, respectively. Most sedations were for laceration repair (38%) and orthopaedic procedures (33%); 89% had no adverse events. Most adverse events were mild, mainly vomiting (8%). Serious adverse events were desaturation in 12 patients, seizures in two patients and chest pain in one patient. The maximum required airway support was bag mask ventilation. No patients aspirated or required intubation.
> Conclusion
> 
> In variation to reported practice elsewhere, almost all procedures in this Australian series were undertaken using nitrous oxide and ketamine. The serious adverse events rate was low.
> 
> 
> Dr David Krieser MB BS FRACP
> Paediatric Emergency Physician
> Director of Paediatric Education
> 
> Sunshine Hospital
> 176 Furlong Road, St Albans VIC 3021
> Tel:  8345 1268
> Fax:  8345 1612
> Pager:  8345 1333
> Email:  [log in to unmask]<mailto:[log in to unmask]>
> 
> 
> On 19 Feb 2015, at 2:11 am, Joe Nemeth, Dr <[log in to unmask]<mailto:[log in to unmask]>> wrote:
> 
> HI Mike-
> 
> Use it routinely at the Montreal General Hospital (tertiary care adult trauma center) and sparingly have used at the MChildren'sH...anecdotal evidence but no adverse effects...great agent...
> 
> .3-.5/kg..or start drip...
> 
> jn
> 
> ---------------------------------------------
> Joe Nemeth MD CCFP (Emergency Medicine)
> Associate Professor
> Pediatrics, Family Medicine
> Director
> Department of Emergency Medicine
> Montreal General Hospital
> McGill University Health Center
> 
> 
> 
> ________________________________________
> From: Pediatric Emergency Medicine Discussion List [[log in to unmask]<mailto:[log in to unmask]>] on behalf of Michael Falk [[log in to unmask]<mailto:[log in to unmask]>]
> Sent: Wednesday, February 18, 2015 8:10 AM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: ketamine
> 
> I am running my EM residents through some Pediatric Trauma cases and an
> interesting question came up that I said I would bring to the listserv...is
> anyone using Ketamine routinely for RSI/pain control in Pediatric trauma?
> 
> I know from colleagues who have served in Iraq and Afghanistan that it is
> the standard drug for the military because of it's hemodynamic stability
> and the fact that there is no evidence that it has any impact on ICP....but
> was curious to see if any of the big Children's Hospitals and trauma
> centers have started to use it?
> Thanks,
> Mike
> 
> Mike Falk, MD, FAAP, FRCP(C)
> Director ED Simulation Fellowship
> Director of ED Simulation,
> Department of Emergency Medicine
> Mount Sinai St. Luke's/
> Mount Sinai Roosevelt Hospital
> New York, NY
> 
> For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                http://listserv.brown.edu/ped-em-l.html
> 
> 
> WARNING: This message originated from outside the Northern/Melbourne/Western Health e-mail network. The sender cannot be validated. Caution is advised. Contact IT Services (+61 3 ) 9342 8888 for more information.
> 
> WARNING: This message originated from outside the Northern/Melbourne/Western Health e-mail network. The sender cannot be validated. Caution is advised. Contact IT Services (+61 3 ) 9342 8888 for more information.
> 

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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