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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