26 Adverse Events in Pediatric Ketamine Sedations with and Without Morphine Pretreatment

Abstract

Purpose: To assess outcomes between two groups of patients receiving ketamine for procedural sedations in our pediatric emergency department. Our hypothesis is that there is no difference in the number of adverse events in ketamine sedations with and without morphine pretreatment. Method: This was a retrospective cohort study of all ketamine sedation records over 15 months. The number and types of adverse events between patients with and without morphine pretreatment were compared, using a z-score and p-values were obtained. The possible influence of midazolam co-administration was examined, using Fisher's exact and Pearson chi-square tests. Results: 858 sedations were reviewed. Age, weight, and medication dosages were similar in each group. 21 adverse events were recorded in the group of patients with no morphine pretreatment; and, 13 adverse events in the group with morphine pretreatment. No significant differences were found for the number or types of events. There was no difference for the frequency of midazolam co-administration, Pearson chi-square, p = 0.994; nor for the number of adverse events in each group, Fisher's exact test, p= 0.465. The mean time from morphine administration to procedural sedation was 114.7 minutes. One adverse event occurred in the 15 min or less time interval. Conclusions: We found no increased adverse events with morphine pretreatment in ketamine sedations for children. Prospective studies to validate these findings, including an effect of timing of analgesia administration are warranted.