From the Pediatric Emergency Department, La Paz University Hospital, Madrid, Spain.
Pediatr Emerg Care. 2024 Sep 1;40(9):654-659. doi: 10.1097/PEC.0000000000003150. Epub 2024 May 9.
Ketamine is a safe and widely used sedative and analgesic in children. The purpose of this study is to evaluate the response to sedoanalgesia for painful procedures in the pediatric emergency department.
A retrospective study was conducted in children younger than 16 years who underwent painful procedures with intravenous/intranasal ketamine between January 2016 and December 2022. We collected demographic variables, effectiveness, route of administration, indication, dose, sedation strategy, duration of procedure, and associated adverse effects.
A total of 671 ketamine sedation procedures (411 males/260 females) were included, with a mean age of 7.2 years. Closed reduction was the most common painful procedure (53.8%), followed by burn healing (24.6%). Ketamine was administered intravenously in 93.4% of procedures and intranasally in 6.6%. The result of sedoanalgesia was satisfactory in 84.9% and unsatisfactory in 15.1%. The percentage of cases with unsatisfactory analgesia was higher with intranasal administration (36.4%; P < 0.001). In the intravenous group, the percentage of cases with unsatisfactory effectiveness (28.7%) was higher for patients younger than 2 years of age ( P < 0.001). Arthrocentesis procedures were associated with the highest percentage of unsatisfactory sedoanalgesia failures among patients receiving intravenous ketamine (39.3%; P < 0.001). Intranasal ketamine patients who received a dose between 3.6 and 4 mg/kg had a significantly higher percentage of unsatisfactory sedoanalgesia (66.7%; P = 0.048). Patients receiving intravenous ketamine had significantly higher rates of unsatisfactory sedoanalgesia when the initial dose interval was 1.6 to 2 mg/kg (11.8%; P = 0.002) and when the final total dose was also 1.6 to 2 mg/kg (17.6%; P = 0.002).
This study concludes that intravenous/intranasal ketamine can provide safe and successful analgesia in pediatric patients in the ED. At intravenous doses of 1-1.5 mg/kg, good effectiveness was achieved in almost 90% of cases. Arthrocentesis had the highest percentage of unsatisfactory results. Repeat dosing should be considered for procedures longer than 20 minutes.
氯胺酮是一种安全且广泛应用于儿童的镇静和镇痛药物。本研究旨在评估在儿科急诊中对疼痛性操作进行镇静镇痛的效果。
对 2016 年 1 月至 2022 年 12 月期间接受静脉/鼻内氯胺酮镇静镇痛的 16 岁以下儿童进行回顾性研究。我们收集了人口统计学变量、效果、给药途径、适应证、剂量、镇静策略、操作持续时间和相关不良事件。
共纳入 671 例氯胺酮镇静镇痛操作（411 例男性/260 例女性），平均年龄为 7.2 岁。闭合复位是最常见的疼痛性操作（53.8%），其次是烧伤愈合（24.6%）。93.4%的操作给予静脉内氯胺酮，6.6%给予鼻内氯胺酮。84.9%的镇静镇痛效果满意，15.1%的效果不满意。鼻内给药的不满意镇痛比例更高（36.4%；P < 0.001）。在静脉内组中，2 岁以下患者的不满意效果比例（28.7%）更高（P < 0.001）。接受静脉内氯胺酮的关节穿刺术患者的镇静镇痛失败比例最高（39.3%；P < 0.001）。接受 3.6 至 4mg/kg 剂量的鼻内氯胺酮患者的不满意镇静镇痛比例显著更高（66.7%；P = 0.048）。静脉内氯胺酮初始剂量间隔为 1.6 至 2mg/kg（11.8%；P = 0.002）和最终总剂量也为 1.6 至 2mg/kg（17.6%；P = 0.002）时，患者的不满意镇静镇痛发生率显著更高。
本研究表明，静脉/鼻内氯胺酮可为儿科急诊患者提供安全有效的镇痛。静脉内剂量为 1-1.5mg/kg 时，近 90%的病例效果良好。关节穿刺术的效果最不满意。对于持续时间超过 20 分钟的操作，应考虑重复给药。
