A Pilot Experience of the use of Intramuscular Ketamine for Paediatric Sedation in an Accident and Emergency Department

Abstract

A prospective uncontrolled clinical trial was conducted to study the effectiveness and safety of using intramuscular ketamine in Accident & Emergency department in Hong Kong. Initial dose of 4 mg/kg (followed by a supplemental dose of 2–4 mg/kg if required) intramuscular ketamine was given to 35 children (between the ages of one to fourteen) to facilitate the carrying out of painful but necessary procedures. Satisfactory or acceptable sedation was obtained in more than 97% of these children without adjuvant physical restraint or local anaesthesia. The mean onset time was 6.78 minutes and mean time to regain consciousness was 94.97 minutes. Mean length of hospital stay was 186.65 minutes. None of these children developed laryngospasm, respiratory depression or cardiovascular instability. Trivial oxygen desaturation was observed in one child secondary to hypersecretion of saliva but he responded to suction and oxygen with no adverse sequel. The incidence of hypersalivation was 8.6%. Other side effects such as emesis (23.5%), muscle spasm (11.85%) were self-limiting There was no case of upsetting reaction observed. Ketamine by intramuscular route provides a better option to facilitate painful procedures in children in Accident & Emergency department as compared with the application of physical restraint. Yet expertise and equipment for advanced airway management is necessary for the uncommon risk of airway complications.