Ideal ketamine dose for pediatric sedation

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Ideal ketamine dose
What's the ideal sedation dose for kids 3-18 years: 1mg/kg, 1.5mg/kg, or 2mg/kg?  This randomized trial found that all doses were effective and produced the same level of sedation, but the 1mg/kg dose required more frequent redosing and resulted in lower physician satisfaction.  Higher doses were just as safe as lower.

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I think 1.5mg/kg is the sweet spot.  If I have a younger child with a more noxious procedure, I will start with 2mg/kg.  In older teens or adults, I often start with 50mg even if, based on their weight, I could start higher.  What dose does the community of Feeders use (click for a poll)?

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Abstract

Am J Emerg Med. 2016 Aug;34(8):1347-53. doi: 10.1016/j.ajem.2016.03.064. Epub 2016 Apr 2.

Optimal dosing of intravenous ketamine for procedural sedation in children in the ED-a randomized controlled trial.

Kannikeswaran N1, Lieh-Lai M2, Malian M3, Wang B4, Farooqi A5, Roback MG6.

Author information:

1Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI 48201. Electronic address: nkannike@dmc.org.

2Wayne State University School of Medicine, Chicago, IL 60654; Accreditation Council for Graduate Medical Education, Chicago, IL 60654.

3Department of Pharmacy Services, Children's Hospital of Michigan, Detroit, MI 48201.

4Wayne State University School of Medicine, Detroit, MI 48201.

5Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201.

6University of Minnesota Medical School, Minneapolis, MN 55455.

Abstract

OBJECTIVE:

The objective of the study is to compare need for redosing, sedation efficacy, duration, and adverse events between 3 commonly administered doses of parenteral ketamine in the emergency department (ED).

METHODS:

We conducted a prospective, double-blind, randomized controlled trial on a convenience sample of children 3 to 18years who received intravenous ketamine for procedural sedation. Children from each age group (3-6, 7-12, and 13-18years) were assigned in equal numbers to 3 dosing groups (1, 1.5, and 2mg/kg) using random permuted blocks. The primary outcome measure was need for ketamine redosing to ensure adequate sedation. Secondary outcome measures were sedation efficacy, sedation duration, and sedation-related adverse events.

RESULTS:

A total of 171 children were enrolled of whom 125 (1mg/kg, 50; 1.5mg/kg, 35; 2mg/kg, 40) received the randomized dose and were analyzed. The need for ketamine redosing was higher in the 1mg/kg group (8/50; 16.0% vs 1/35; 2.9% vs 2/40; 5.0%). There was no significant difference in the median Ramsay sedation scores (5.5 [interquartile range {IQR}, 4-6] vs 6 [IQR, 4-6] vs 6 [IQR, 5-6]), FACES-R score (0 [IQR, 0-4] vs 0 [IQR, 0-0] vs 0 [IQR, 0-0]), sedation duration in minutes (23 [IQR, 19-38] vs 24.5 [IQR, 17.5-34.5] vs 23 [IQR, 19-29]), and adverse events (10.0% vs 14.3% vs 10.0%) between the 3 dosing groups. Physician satisfaction was lower in the 1mg/kg group (79.6% vs 94.1% vs 97.3%).

CONCLUSIONS:

Adequate sedation was achieved with all 3 doses of ketamine. Higher doses did not increase the risk of adverse events or prolong sedation. Ketamine administered at 1.5 or 2.0mg/kg intravenous required less redosing and resulted in greater physician satisfaction.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27216835 [PubMed - in process