277 Intranasal Ketamine for Peripheral Venous Access: A Randomized Double Blind and Placebo-Controlled Study

Abstract

Effectiveness of intranasal ketamine as an analgesic and sedative for pediatrIc procedures in pediatric intensive care unit (PICU) has been reported previously. Few studies avaluated IN ketamine comparing with placebo as sedative agent. Verify the efficacy of intranasal ketamine as sedative agent for venous access. Randomized, double blind, placebo-controlled study conducted at PICU from November 2015 to August 2016. Children needing venous access were randomized to receive intranasal ketamine (4mg/Kg) or normal saline solution. Groups were compared regarding the time for venous access, facility for performing the procedure, adverse events, disturbances in vital signs and perception of the accompanying adult. 39 children (21 Ketamine; 18 Placebo) were included without differences regarding to age, sex, weight, reason for hospitalization and professional experience. The median age was similar (19.8 x 15.8 months), as well as the median weight (10.0 x 11.3Kg). Ketamine reduced the length for venous access (23.0 x 67.5 seconds; p=0.01), and facilitated the procedure (p=0.00009). Ketamine induced sleepiness 15 minutes after its administration (p=0.003) and reduced the number of people for the child’s restraint (p=0.025). No difference was verified between groups regarding adverse effects or vital signs disturbances. Side effects were observed in 29% of the children in the Ketamine group and 17% in the Placebo group, irritability being the most common for both. The accompanying adult reported that 81% of children in ketamine group were calm and quiet (p=0.0003). Intranasal ketamine reduces the time for venous puncture, facilitates the procedure to the nurse, and provides a calm environment.