Green S M, Rothrock S G, Lynch E L, Ho M, Harris T, Hestdalen R, Hopkins G A, Garrett W, Westcott K
Department of Emergency Medicine, Loma Linda University School of Medicine, CA, USA.
Ann Emerg Med. 1998 Jun;31(6):688-97. doi: 10.1016/s0196-0644(98)70226-4.
To determine the safety of intramuscular ketamine when administered by emergency physicians for pediatric procedures in accordance with a defined protocol.
We assembled a consecutive case series of children aged 15 years or younger who were given ketamine in the emergency departments of a university medical center and an affiliated county hospital over a 9-year period. A protocol for ketamine use (4 mg/kg, intramuscularly) was followed. Treating physicians were instructed to complete data forms recording complications and adequacy of sedation concurrent with patient care. Subsequent chart review was used to determine indications, adjunctive drugs, time to discharge, and adverse reactions for all patients.
Intramuscular ketamine was administered 1,022 times, mainly for laceration repair and fracture reduction. Physicians completed data forms for 431 of treated children (42%). Transient airway complications occurred in 1.4%: airway malalignment (n = 7), laryngospasm (n = 4), apnea (n = 2), and respiratory depression (n = 1). All were quickly identified and treated without intubation or sequelae. Emesis occurred in 6.7%, without evidence of aspiration. Mild recovery agitation occurred in 17.6%, moderate to severe agitation in 1.6%. No child required hospitalization for complications caused by ketamine. Ketamine produced acceptable sedation in 98% of patients. The median time from injection to emergency department discharge was 110 minutes for children given a single dose of ketamine.
Intramuscular ketamine may be administered safely by emergency physicians to facilitate pediatric procedures in accordance with a defined protocol and with appropriate monitoring. Ketamine is highly effective, has a wide margin of safety, does not require intravenous access, and uniquely preserves protective airway reflexes.
根据既定方案，确定急诊医生在儿科手术中使用肌肉注射氯胺酮的安全性。
我们收集了一个连续病例系列，这些病例为15岁及以下的儿童，他们在一所大学医学中心和一家附属县医院的急诊科在9年期间接受了氯胺酮治疗。遵循氯胺酮使用方案（4毫克/千克，肌肉注射）。治疗医生被要求在提供患者护理的同时填写记录并发症和镇静充分性的数据表格。随后通过查阅病历确定所有患者的用药指征、辅助药物、出院时间和不良反应。
肌肉注射氯胺酮1022次，主要用于伤口缝合修复和骨折复位。医生为431名接受治疗的儿童（42%）填写了数据表格。短暂气道并发症发生率为1.4%：气道错位（n = 7）、喉痉挛（n = 4）、呼吸暂停（n = 2）和呼吸抑制（n = 1）。所有这些情况均被迅速识别并治疗，无需插管，也未留下后遗症。呕吐发生率为6.7%，无吸入证据。轻度恢复躁动发生率为17.6%，中度至重度躁动发生率为1.6%。没有儿童因氯胺酮引起的并发症而需要住院治疗。氯胺酮在98%的患者中产生了可接受的镇静效果。接受单剂量氯胺酮治疗的儿童从注射到急诊科出院的中位时间为110分钟。
急诊医生可根据既定方案并在适当监测下安全地使用肌肉注射氯胺酮以辅助儿科手术。氯胺酮高效、安全性高、无需静脉通路，且能独特地保留气道保护性反射。
