Radiologist-Supervised Ketamine Sedation for Solid Organ Biopsies in Children and Adolescents

Abstract

Pediatric interventional radiologists are frequently challenged when faced with organ biopsies. Because of the need for patient immobility and the potential risk of morbidity with patient movement during biopsies, many radiologists prefer general anesthesia to sedation. We present our experience with radiologist-supervised ketamine sedation in pediatric patients undergoing renal and hepatic biopsies. Quality assurance data were accessed from a computerized database that prospectively collects demographics, outcome parameters, and adverse events on all patients who receive ketamine sedation. Patients received an IV ketamine bolus of 2 mg/kg followed by a continuous infusion of ketamine of up to 150 mcg/kg/min titrated to the responsiveness of the patient. Sixty-five children received ketamine for liver (n = 35) and renal (n = 30) biopsies. The mean age of the study group was 7.0 +/- 2.7 (SD) years. The cohort included patients with an American Society of Anesthesiologists (ASA) physical status classification of ASA 1 (3%), ASA 2 (78%), and ASA 3 (19%). The duration of ketamine sedation averaged 39 +/- 20 (SD) minutes, with an average procedure time of 32 +/- 19 (SD) minutes. All procedures were successfully completed, and there were no major adverse events. Interventional radiologists performing solid organ biopsies in the pediatric population often use general anesthesia to ensure immobility, adequate analgesia, and safe conditions. Our experience suggests that interventional radiologists may supervise a nurse-administered ketamine protocol to provide safe, effective analgesia and sedation for liver and renal biopsies.